Another big concern, according to Dr. Cefalu, is psychotic behavior; a formal socialization process, which could include games, movies, music, and group activities, may be effective in the short-term for nonacute situations. Acute situations, however, may require reorienting the patient. If the person is in danger of harming self or others, it may be necessary to resort to chemical and/or physical restraints.)
Dr. Cefalu said that CST is not routinely used in nursing homes because staff are not trained in CST. Its effectiveness depends on the experience level of the person administering the therapy, how CST is delivered to the patient, and the level of dementia.
He pointed out that staff education is the most important and effective way to manage neuropsychiatric symptoms. The only limiting factor is the time it takes to educate the staff.
He suggested that a staff member be trained as the inservice staff person who can train others. The key to success with this, Dr. Cefalu said, is a culture change that results in staff implementing this type of behavior management on an ongoing basis. It requires a fairly stable staff without a lot of turnover, and a motivated staff that actually understands the rationale behind the behavioral management techniques.
Robin Arnicar, R.N., director of nursing at the Frederick Villa Nursing Center in Baltimore, said her first concern as a caregiver and a director of nursing is always the safety of the residents and staff. She ranked intrusive behaviors by patients with dementia as a close second on her list of concerns, because those behaviors are often the precipitating factor in a physically aggressive episode.
Ms. Arnicar said that utilizing nonpharmacologic therapies as part of the care- planning process is essential.
She has achieved great success with residents in all stages of dementia using Snoezelen therapy–a Dutch therapy that emphasizes relaxation with dim lights and/or music. The key, she said, is finding the right combination of stimuli for each resident.
Ms. Arnicar also pointed out that the ability of caregivers and family members to understand what the resident is capable of accomplishing (cognitively and functionally) is not given the consideration that is warranted, and that programs such as the Claudia Allen's Cognitive Level Screen, conducted by an appropriately trained occupational therapist, can assist caregivers in planning appropriate care and activities.
Ms. Arnicar agreed with Dr. Cefalu that CST in long-term care is infrequently used, and she agreed that staff education is essential in managing neuropsychiatric symptoms. Caregivers who work with patients with dementia must be willing to acquire training, and the facility must be willing to allow sufficient time and resources for training.
“Nursing homes that have a dementia population have many challenges,” Ms. Arnicar said, and added that the key to managing neuropsychiatric symptoms of dementia is to develop a dementia management tool kit that contains a variety of therapy and behavior management techniques, educational resources, and strong care planning processes. It is important to “recognize that not all caregivers enjoy or even have the ability to work in a dementia environment,” Ms. Arnicar added. Therefore, it is necessary to hire and assign work accordingly.
For caregivers, wandering is the most troubling symptom in people with dementia. Dr. CEFALU
It is essentialto use nonpharmacologic therapies as part of the care- planning process. MS. ARNICAR
Psychological Therapies That Make, Or Miss, the Grade