The aging of the planetary population of human beings is a well-known fact for the public health institutions of most countries. Health professionals expect individuals with age-related diseases such as dementia to increase in the next few decades. Delgado et al. (2020) state that “dementia defines a group of conditions involving irreversible neurodegenerative disease, leading to changes in cognition, communication and functional ability” (p. 1). The current years are a window of opportunity to deeply analyze and evaluate existing pharmacological and non-pharmacological care for dementia patients to better prepare for upcoming challenges in the industry.
Pharmacological Methods of Care Provision for Institutionalized Dementia Patients
Judging by the current body of academic literature, while the pharmacological way of providing care for dementia patients in nursing homes is considered a conventional and practical intervention, it is widely criticized. Modern researchers highlight psychotropic drug treatment as the primary approach to delivering care for institutionalized people with dementia via medication (Mesquida et al., 2019). According to Delgado et al. (2020), polypharmacy is another widespread therapeutic practice. Pasina et al. (2020) also mention “antipsychotics, laxatives, benzodiazepines, antiplatelets, and proton pump inhibitors” as drugs used to alleviate dementia patients’ physiological and mental states (p. 1011). Healthcare researchers and practitioners criticize these because they carry several severe risks for those who take them. Mesquida et al. (2019) list “impaired cognitive capacity, rigidity, somnolence, and other complications during the course of the illness” as drug complications with a high risk of occurring (p. 1). The reasons lie beyond the need for complex medical treatment, the highly variable physiological characteristics of institutionalized people with dementia, and the inability to treat dementia completely.
The drivers of complications are the frequently occurring potentially inappropriate prescribing and the lack of a standardized pharmacological methodology for the delivery of care in healthcare. However, there are practical measures that allow health professionals to prevent potentially inappropriate prescribing, avoid the emergence of new symptoms and comorbidities, and implement and promote pharmacological care initiatives more effectively. Some of these are reanalysis and applying multiple guidelines and instructions (Dijk et al., 2022). Experts also advise using multicomponent and interdisciplinary approaches to the design, implementation, and promotion of care strategies. For example, “pharmacists contribute substantially to patient care in nursing homes, ensuring quality use of medication, resulting in reduced fall rates” (Lee et al., 2019, p. 2668). Interventions based on multidisciplinary consensus result in efficient medication, the preservation of material resources in nursing facilities, and better care providers’ cooperation.
Non-pharmacological Methods of Care Provision for Institutionalized Dementia Patients
The non-pharmacological way of providing care for persons with dementia is an alternative that has snowballed over at least the last two decades in nursing homes and academic circles. It includes a multitude of standard and specially designed strategies, approaches, and techniques that target not only the condition but also the accompanying symptoms and problems that people with dementia experience. Among the comprehensive care models, the MACS intervention is one of the most interesting, as it is designed to treat severe cases. According to Diehl et al. (2020), the abbreviation stands for “Motor stimulation, Activities of daily living stimulation, Cognitive stimulation, and Social functioning” (p. 2). It represents an intriguing example of a high-quality, multicomponent care delivery technique that can be applied to many different populations of institutionalized individuals with severe dementia. Care delivery methods with such properties are much needed in mental and neurological healthcare. Moreover, Diehl and their colleagues’ research shows that emphasizing an intervention’s external validity is an effective tactic for promoting it among nursing theorists and practitioners.
There is also much literature on specific care interventions that aim to alleviate patients’ side effects and comorbidities and make minor aspects of their lives more comfortable. Most of them affect the behavior and psychology of affected individuals. Findings from a systematic review by Hayward et al. (2022) show that interventions to promote family involvement in the lives of their relatives at nursing homes positively influence their quality of life and overall mental state.
One of the most common concomitant pathologies in the case of dementia is sleep disturbances. Webster et al. (2022) state that this problem occurs in more than a third of people with dementia staying special nursing facilities. This comorbidity is exhausting and harmful to its bearers and the care providers who look after them. A group of researchers recently approached this problem through an intervention that includes many techniques and uses a multicomponent methodology (Webster et al., 2022). Their solution was found to be effective but demanding on human resources. Wandering is another adverse effect of dementia that makes the lives of patients and nurses more difficult. Like sleep disturbances, it is prevalent in about 40% of institutionalized persons (Wang et al., 2022). Wang et al. developed a practical care method for this specific group of suffering individuals by combining various categories of evidence. Methodological diversity and versatility, interdisciplinary and inter-professional perspective is the key to effectively promoting and implementing nursing pharmacological and non-pharmacological interventions for persons with dementia in homes for the elderly.
References
Delgado, J., Bowman, K., & Clare, L. (2020). Potentially inappropriate prescribing in dementia: A state-of-the-art review since 2007. BMJ Open, 10(1), 1-9.
Diehl, K., Kratzer, A., & Graessel, E. (2020). The MAKS-s study: Multicomponent non-pharmacological intervention for people with severe dementia in inpatient care–study protocol of a randomised controlled trial. BMC Geriatrics, 20(1), 1-12. Web.
Dijk, M. T., Tabak, S., Hertogh, C. M., Kok, R. M., van Marum, R. J., Zuidema, S. U., Sizoo, E. M., & Smalbrugge, M. (2022). Psychotropic drug treatment for agitated behaviour in dementia: What if the guideline prescribing recommendations are not sufficient? A qualitative study. Age and Ageing, 51(9), 1-10. Web.
Hayward, J. K., Gould, C., Palluotto, E., Kitson, E., Fisher, E. R., & Spector, A. (2022). Interventions promoting family involvement with care homes following placement of a relative with dementia: A systematic review. Dementia, 21(2), 618–647.
Lee, S. W. H., Mak, V. S. L., & Tang, Y. W. (2019). Pharmacist services in nursing homes: A systematic review and meta‐analysis. British Journal of Clinical Pharmacology, 85(12), 2668-2688.
Mesquida, M. M., Casas, M. T., Sisó, A. F., Muñoz, I.-G., Vian, Ó. H., & Monserrat, P. T. (2019). Consensus and evidence-based medication review to optimize and potentially reduce psychotropic drug prescription in institutionalized dementia patients. BMC Geriatrics, 19(7), 1-9. Web.
Pasina, L., Novella, A., Cortesi, L., Nobili, A., Tettamanti, M., & Ianes, A. (2020). Drug prescriptions in nursing home residents: An Italian multicenter observational study. European Journal of Clinical Pharmacology, 76(7), 1011-1019. Web.
Wang, J., Zhang, G., Min, M., Xing, Y., Chen, H., Li, C., Li, C., Zhou, H., & Li, X. (2022). Developing a non-pharmacological intervention programme for wandering in people with dementia: Recommendations for healthcare providers in nursing homes. Brain Sciences, 12(10), 1–20. Web.
Webster, L., Costafreda, S. G., Powell, K., & Livingston, G. (2022). How do care home staff use non-pharmacological strategies to manage sleep disturbances in residents with dementia: The SIESTA qualitative study. PLOS ONE, 17(8), 1-14. Web.