Activities and Interventions

Introduction

In this module, you'll learn the importance of providing meaningful, individualized, person-centered activities and how they can help in the following ways:

  1. Reduce overuse of medications
  2. Support a higher quality of life
  3. Encourage intergenerational relationships
  4. Promote good connections between communities and care recipients

Objectives

  • Discuss the current problem of antipsychotic medication use in persons with dementia.
  • Describe how activities can be used as non-pharmacologic interventions.
  • Describe how alternative activities (like Music and Memory, Animals, Art, etc.) has been used in long-term care.
  • Discuss activities that allow people to 'give back'.
  • List the ways young and old can work together to support each other and their communities.


Warm Up

What do you enjoy doing?

  • Take a moment to reflect on what you liked to do as a child.
  • Now think about the activities you like to enjoy now.
  • What has changed? What has remained the same?

The next time you are with a person in your care, find out about their favorite activities then and now.

Dig In

Antipsychotic Medication Usage in Persons with Dementia

The use of antipsychotic medication for people with dementia remains a national problem. In 2012, the Centers for Medicare and Medicaid Services (CMS), along with other stakeholders began the National Partnership to Improve Dementia Care in Nursing Homes and reduce the use of these drugs. Those efforts now include improving care in Assisted Living Facilities (ALF) and group homes where more and more individuals with dementia are receiving care.

Why are antipsychotics in people with dementia considered such a problem?

Antipsychotic medications are largely ineffective. Fewer than 1 in 5 people show an improvement in aggressive behaviors, which is the reason most often given for using these drugs. They can be dangerous. In 2008, the FDA issued a black-box warning against the use of antipsychotic medications in elderly persons with dementia-related psychosis as they were at an increased risk of death.

Here are some antipsychotic medications side effects:

  • Sedation
  • Stiffness
  • Difficulty walking
  • Dehydration
  • Falls
  • Chest Infections
  • Shaking or Tremors (tardive dyskinesia)
  • Faster cognitive decline
  • Increased risk strokes
  • Extreme restlessness (akathisia)

Off-Label Use

Antipsychotics were not designed chemically to be 'anti-agitation/anti-aggression' medications other than their sedating effect. In dementia, the use is called 'off-label' which means they haven't been approved by the Food and Drug Administration (FDA) to be used to control people with dementia-aggressive behavior.

Off-label prescribing is common and is considered an acceptable medical practice. When a practitioner prescribes something off-label, getting informed consent and weighing the risks and benefits becomes even more critical.

Wrap Up

Two questions must be asked by prescribers of all medications:

  • Will it help? (What are the benefits?)
  • Will it hurt? (What are the risks?)

Antipsychotics only rarely help a person with dementia and only at considerable risk of harm. From the perspective of person-directed care, prescribing antipsychotic medication misses the point of behavior as communication. Prescribing antipsychotic medication too soon may keep us from learning what the person is trying to tell us.

Antipsychotic medication misuse has decreased across Texas but there is still room for improvement.