dementia and behaviour modification

The protocols and use of medications at Prairie Valley Lodge

The overuse of medications, especially anti-psychotic medications in long term care facilities is a valid concern for many families. It is something we are asked about frequently. There is a belief that facilities are able to administer this type of medication at will. However at Prairie Valley Lodge anti-psychotic medications cannot be administered without a full medical and mental health assessment from a doctor or other medical professional. When a family is involved and active in the implementation of the residents care plan the use of any medication without the full understanding and permission of the resident or the family is not a possibility.

Anti-psychotic medications may sometimes play a role in the management of severe responsive behaviours in the dementia patient, but the first course of action is always behaviour intervention. Responsive behaviours often occur with dementia and are usually triggered by grief, loss, fear, pain, anxiety etc. All of which are overwhelming and distressing emotions that cannot be appropriately articulated by the resident at this stage of their disease, and may present as screaming, moaning, and verbal and physical aggression.

To initiate positive behaviour modification it is important that care givers learn as much as possible about the person that they are caring for. For this purpose upon admission we try to discover the Life Story of the resident. Some questions that we ask at this time would be; what brings joy into the persons life, what was their occupation, what were their hobbies, what do they consider their greatest accomplishments? We like to discover their special likes and dislikes, sleeping habits, favourite foods, preferred bath times etc. Family members can assist hugely in the process of sharing the Life Story with the care giver.

The Life Story, or knowing your resident well, (Person Centred Care) is often a simple and practical way to modify the residents responsive behaviours. For example, it can be arranged that a family member or a care giver accompany the resident for a daily walk. This may ease the agitated mind of a person who liked to be outside in the sunshine and feels trapped being confined inside a facility. Some of our ladies at Prairie Valley Lodge like to fold laundry. It makes them feel useful (it is useful!), it gives them a great sense of purpose.

So the answer is that sometimes anti-psychotic drugs are necessary to assist with the management of severe responsive behaviours of dementia. Especially when those behaviours (usually physical aggression) pose a risk to both the patient and those around them. However families should rest assured that medication is not a preferred first line method of intervention, but usually the very last. Often it is used for peace of mind for the resident and in turn their family members. The answer to good dementia management is always a collaborative effort by family members, care staff and GP/medical specialists.