From: hounddog23x@gmail.com   
      
   "The evidence for non-pharmaceutical approaches to the behavior problems often   
   seen in dementia is better than the evidence for antipsychotics, and far   
   better than for other classes of medication," says Helen C. Kales.    
      
      
      
      
      
   5 WAYS TO EASE DEMENTIA WITHOUT DRUGS    
      
      
   JOHNS HOPKINS UNIVERSITY, UNIVERSITY OF MICHIGANrightOriginal Study    
      
   Posted by Kara Gavin-U. Michigan on March 5, 2015    
      
   You are free to share this article under the Attribution 4.0 International   
   license.    
   Doctors write millions of prescriptions a year for drugs to calm people with   
   Alzheimer's disease and other forms of dementia. But research suggests that   
   non-drug approaches actually work better, and carry far fewer risks.    
      
   A new study is the result of two decades' worth of research on drugs like   
   antipsychotics and antidepressants, and non-drug approaches that help   
   caregivers address behavioral issues in dementia patients.    
      
   The findings recommend that non-drug approaches that focus on training   
   spouses, adult children, or staff in nursing homes and assisted living   
   facilities should be the first choice for treating symptoms such as   
   irritability, agitation, depression, anxiety,   
    sleep problems, aggression, apathy, and delusions.    
      
   TAILORED APPROACH    
   To address this, researchers created DICE (Describe, Investigate, Evaluate,   
   and Create), a framework that doctors and caregivers can use to make the most   
   of what's already known. The framework is tailored to each person with   
   dementia and can be adapted    
   as symptoms change.    
      
   "The evidence for non-pharmaceutical approaches to the behavior problems often   
   seen in dementia is better than the evidence for antipsychotics, and far   
   better than for other classes of medication," says first author Helen C.   
   Kales, head of the Program    
   for Positive Aging at the University of Michigan Health System and an   
   investigator at the VA Center for Clinical Management Research.    
      
   "The issue and the challenge is that our health care system has not   
   incentivized training in alternatives to drug use, and there is little to no   
   reimbursement for caregiver-based methods."    
      
   GAO REPORT    
   Coincidentally, a new report from the US Government Accountability Office,   
   addresses the issue of overuse of antipsychotic medication for the behavior   
   problems often seen in dementia.    
      
   It finds that one-third of older adults with dementia who had long-term   
   nursing home stays in 2012 were prescribed an antipsychotic medication--and   
   that about 14 percent of those outside nursing homes were prescribed an   
   antipsychotic that same year.    
      
   The GAO calls on the federal government to work to reduce use of these drugs   
   further than it's already doing, by addressing use in dementia patients   
   outside nursing homes.    
      
   But penalizing doctors for prescribing antipsychotic drugs to these patients   
   could backfire, if caregiver-based non-drug approaches aren't encouraged,   
   Kayles warns.    
      
   In the new paper, published in the British Medical Journal, Kayles and   
   coauthors Laura N. Gitlin and Constantine Lyketsos, both of Johns Hopkins   
   University, write "there needs to be a shift of resources from paying for   
   psychoactive drugs and emergency    
   room and hospital stays to adopting a more proactive approach."    
      
   5 APPROACHES    
   "Drugs still have their place, especially for the management of acute   
   situations where the safety of the person with dementia or family caregiver   
   may be at risk," they write.    
      
   For instance, antidepressants make sense for dementia patients with severe   
   depression, and antipsychotic drugs should be used when patients have   
   psychosis or aggression that could lead them to harm themselves or others. But   
   these uses should be closely    
   monitored and ended as soon as possible,    
      
   The authors lay out five non-pharmacologic categories to start with based on   
   their review of the medical evidence that have been shown to help reduce   
   behavior issues:    
      
   Provide education for the caregiver.    
   Enhance effective communication between the caregiver and the person with   
   dementia.    
   Create meaningful activities for the person with dementia.    
   Simplify tasks and establishing structured routines.    
   Ensure safety and simplify and enhance the environment around the patient,   
   whether in the home or the nursing/assisted living setting.    
   Many "hidden" medical issues in dementia patients--including urinary tract   
   infection and other infections, constipation, dehydration, and pain--can lead   
   to behavioral issues, as can drug interactions, the researchers note. So   
   physicians should look to    
   assess and address these wherever possible.    
      
   ROLLING THE DICE    
   The researchers will launch a National Institute of Nursing Research-sponsored   
   clinical trial this spring that will test the DICE approach through a computer   
   based tool for caregivers called the WeCareAdvisor.    
      
   The tool will help families identify tips and resources in a single computer   
   interface to address behavioral symptoms.  The tips are designed to prevent or   
   mitigate possible triggers for common behavioral symptoms such as pacing,   
   repetitive questioning,    
   restlessness, or shadowing.    
      
   RELATED ARTICLES    
   ON FUTURITY    
      
   bandaged arm    
   Johns Hopkins University    
   Drug combo heals wounds fast with less scarring    
      
   "There is potential promise for the role of gold drugs as a part of bone   
   cancer treatment in dogs and potentially in people, although more studies are   
   needed before we can use them in a clinical setting," says Valery Scharf.   
   (Credit: Roman Boed/Flickr)    
   Michigan State University    
   'Gold salts' may fight bone cancer in dogs and people    
      
   two honey bees    
   University of Queensland    
   Bee brain hints at how we make memories    
      
   For instance, de-cluttering the environment, using music or simple activities   
   that help to engage a person with dementia , or using a calm voice instead of   
   being confrontational, could help greatly to reduce behavioral symptoms, Kales   
   says.    
      
   Further, making sure that caregivers get breaks from their responsibilities   
   and take care of themselves, especially in the home, can help them avoid   
   burnout and taking their frustration out on patients.    
      
   "Behavior-based strategies may take longer than prescriptions," Kales   
   acknowledges. "But if you teach people the principles behind DICE, the   
   approach becomes more natural and part of one's routine. It can be very   
   empowering for caregivers or nursing home    
   staff."    
      
   The National Institutes of Health and the Johns Hopkins Alzheimer's Disease   
   Research Center funded the work.    
      
      
   [continued in next message]   
      
   --- SoupGate-Win32 v1.05   
    * Origin: you cannot sedate... all the things you hate (1:229/2)