The psychological well-being of individuals with dementia in nursing homes is an important aspect of their overall care. Dementia is a progressive neurodegenerative condition that affects cognitive functions, memory, behaviour, and emotions.

There are several steps and strategies for treating psychological distress:

 

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Step 1: Full Clinical Biopsychosocial Assessment

To effectively address psychological distress in individuals with dementia, a thorough biopsychosocial assessment is crucial. This approach considers the psychological, biological, social, and environmental factors that may influence the individual’s psychological well-being.

1. Psychological: Assess cognitive function, emotional states, and behavioural changes.
2. Biological: Review any underlying medical conditions or medications that could be influencing mood or behaviour.
3. Social: Consider the person’s social environment, including family relationships and social interactions.
4. Environmental: Evaluate the physical environment to ensure it supports the resident’s needs and reduces stressors.

This comprehensive assessment should involve healthcare professionals, such as GPs, Psychiatrists, Nurse Specialists, Occupational Therapists and Psychologists. Standardised tools and questionnaires designed for dementia patients can provide valuable insights. It is also essential to include collateral from caregivers and family members, as they have intimate knowledge of the individual’s history and preferences.

A thorough medical evaluation is necessary to rule out any medical causes for changes in behaviour or mood. Conditions like pain, infection, or medication side effects can exacerbate psychological symptoms. Close observation of the individual’s behaviour is key to determining appropriate treatment.

The ABC (Antecedent-behaviour-Consequence) Chart is a useful observational tool to help identify patterns in behaviour. By documenting what happens before, during, and after a behaviour, one can identify triggers and responses. For example, if removing the individual from a noisy environment helps alleviate distress, it could suggest that environmental factors, such as noise or harsh lighting, are contributing to the behaviour.

 

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Step 2: Intervention Strategies

According to National Guideline No. 21, non-pharmacological interventions should be considered as the first line of treatment, unless there is a high-risk environment involving physical aggression. When possible, these interventions should be explored before resorting to medications.

Non-Pharmacological Interventions:

See Interventions for NCSD & Factors to Consider »

1. Maintain Consistency: Establishing a consistent daily routine can help reduce anxiety and confusion for individuals with dementia.
2. Encourage Familiar Activities: Engage residents in activities that are linked to their previous hobbies or interests, promoting a sense of purpose and enjoyment.
3. Adapt Activities to Abilities: It is essential to match activities to the cognitive and functional abilities of the person. Overly complex activities can increase stress and worsen non-cognitive symptoms of dementia.
4. Person-centred Approach: Always remember to meet the person where they are - cognitively and emotionally. Tailoring interventions to their current state can significantly improve their well-being.

In cases where non-pharmacological interventions are insufficient and aggressive behaviours escalate, medication may be considered. However, medications should be used cautiously, tailored to the individual's specific needs and health status. Medications should always be combined with non-pharmacological interventions for the best outcomes.

As a caregiver, it is crucial to communicate any concerns to the relevant medical professionals, who will assess the individual’s medical history and current health status. The use of medication in managing non-cognitive symptoms of dementia requires a careful balance to minimise potential side effects. Ongoing assessment is essential to adjust dosages and monitor for side effects, particularly as older adults may be more sensitive to medications.

Interdisciplinary collaboration among healthcare providers, including GPs, nurses, and mental health professionals, is critical for creating and maintaining an effective, comprehensive care plan.

 

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Step 3: Ongoing Monitoring

Once interventions have been implemented, ongoing monitoring of non-cognitive symptoms is necessary. If medications are introduced, it’s important to monitor their effectiveness and any potential side effects. Careful tracking can help assess whether the medication is achieving the desired effect.

When appropriate, a trial reduction of medications should be considered to minimise polypharmacy and reduce the risk of side effects. Regular reassessment of the patient’s symptoms, as well as collaboration with healthcare providers, can help ensure that the care plan remains aligned with the individual’s evolving needs. This ongoing monitoring process is crucial for optimising care and improving the quality of life for individuals living with dementia.

See National Guideline No. 21 »

 

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By following these steps, healthcare providers can create a well-rounded approach to managing psychological distress in individuals with dementia, ensuring that care remains person-centred, adaptable, and effective.