Week 11: What are the non-medication treatment approaches? - Part II

Last week we began to review some of the non-medication treatments that have been studied to improve behavior, cognition, function and quality of life for people with dementia. We continue this week with more examples.

• Light therapy
Patients may become more restless and confused in dark environments. It is referred to as ‘sundowning’ and may be caused by an upset body clock. Melatonin is a hormone that keeps our sleeping patterns in tune with the 24-hour cycle of day and night. Every day, as the sun goes down, our levels of melatonin increase and we begin to feel less alert. When the sun comes up, our levels of melatonin decrease quickly. Increasing light levels during the day could help to prevent ‘sundowning’ and disrupted sleep for patients. In light therapy, the patient sits in front of a light box that provides about 30 times more light than the average office light, for a set amount of time each day. This has improved effect on restlessness and on disturbed sleep for patients in some studies.

• Aromatherapy
This may reduce agitated behaviors. Lemon balm and lavender oils have been most commonly used. There is a reduction in behavioral problems in people who received arm massage with lemon balm compared with those who received arm massage with an odorless cream. Lavender oil placed in a sachet on each side of the pillow for at least one hour during sleep may reduce agitated behaviors.

• Nonphysical barriers
They have long been used as a non-restraining method of preventing wandering. They include camouflaging exits by painting them to look like bookcases, painting a black square in front of an elevator to make it look like a hole, and placing a thin Velcro strip across doorways.

• Caregiver support
Help family members care for the patient and themselves.
Caregiver interventions have a positive effect on behavioral problems in patients.
It is important to remind caregivers not to take it personally. Disturbing behaviors of patients lack intentionality and are part of the normal progression of the disorder. Caregivers also need to appreciate that hallucinations are normal in these patients and do not necessarily require medications if they do not disturb the patient or place the patient or anyone else at risk.
Do not try to reason with the patient; instead redirect him or her. Offer caregivers suggestions for reassuring or distracting agitated patients rather than trying to reason with them. Encourage caregivers to maintain routines and consistency. Using low calm tone of voice, giving simple instructions, and leaving and then reattempting care that is refused initially can be effective. Give positive rewards for desired behaviors and do not reward negative behaviors.
Recommend that caregivers create a safe environment. Encourage them to use locks, alarms, or ID bracelets as appropriate if patients are prone to wandering.
Active involvement of caregivers in making choices about treatment distinguishes effective from ineffective support programs, decreases the odds of institutionalization, and may lengthen time to institutionalization.