Nursing Home Checklist: Non-Pharmacological Approaches Before Referral to Psychiatry of Later Life (POLL)

This checklist ensures that all non-pharmacological interventions have been explored before referring a resident to the Psychiatry of Later Life team.

1. Medical & Physical Health Review

☐ Recent GP review to rule out medical causes (e.g., infections, pain, dehydration)
☐ Blood tests completed (e.g., full blood count, electrolytes, thyroid function, vitamin B12, folate)
☐ Review for signs of delirium using a validated tool (e.g., 4AT, CAM)
☐ Check for untreated pain (assess using Abbey Pain Scale if non-verbal)
☐ Assessment for sensory impairments (hearing loss, vision changes, need for hearing aids/glasses)
☐ Recent medication review (consider anticholinergics, benzodiazepines, opioids, polypharmacy effects)

2. Environment & Routine Adjustments

☐ Review noise levels and reduce environmental overstimulation (TV, loud staff conversations, alarms)
☐ Ensure consistent daily routine with familiar staff where possible
☐ Use of appropriate lighting to reduce shadows and minimise sundowning effects
☐ Removal or covering of mirrors if causing distress
☐ Provision of clear signage and visual cues for orientation (e.g., contrasting toilet doors, name labels)

3. Communication Strategies

☐ Staff using clear, slow, and calm communication with simple instructions
☐ Use of reassurance and validation therapy instead of correcting false beliefs
☐ Encouraging use of visual prompts, gestures, and assistive communication aids
☐ Ensuring eye contact and non-threatening body language

4. Psychological & Behavioural Interventions

☐ Use of distraction techniques (e.g., music, reminiscence therapy, engaging in activities)
☐ Implementing individualised meaningful activities (e.g., sensory activities, fidget blankets)
☐ Life story work completed and used to tailor care interactions
☐ Encouraging social engagement and peer interaction within the home
☐ Trial of one-to-one companionship or emotional support

5. Sleep & Night-time Behaviour Management

☐ Establishing a consistent bedtime routine
☐ Reducing caffeine intake in the evening
☐ Use of non-medicated sleep aids (weighted blankets, aromatherapy, relaxation music)
☐ Ensuring toileting needs are met before bed to reduce night-time agitation
☐ Adjusting lighting to support circadian rhythm (e.g., soft night lights, blackout curtains)

6. Nutrition & Hydration Considerations

☐ Ensuring adequate hydration throughout the day
☐ Encouraging a balanced diet with sufficient protein and micronutrients
☐ Identifying and accommodating food preferences to maintain interest in meals
☐ Offering small, frequent meals if the resident struggles with larger portions
☐ Addressing swallowing difficulties with SLT referral if needed

7. Pain & Discomfort Management

☐ Regular assessment for pain indicators in non-verbal residents
☐ Ensuring correct seating, posture, and pressure relief to prevent discomfort
☐ Trial of massage, warm compresses, or repositioning before considering medication
☐ Referral to physiotherapy or occupational therapy for mobility-related pain

8. Toileting & Personal Care Considerations

☐ Ensuring easy access to the toilet and use of contrasting colours for visibility
☐ Checking for constipation or urinary retention as a source of agitation
☐ Assessing for discomfort due to incontinence products
☐ Encouraging regular toileting to avoid accidents and distress

9. Responsive Behaviour Management

☐ Identifying and addressing triggers for aggression, agitation, or wandering☐ Using gentle redirection rather than restraint or confrontation
☐ Providing safe wandering spaces if needed
☐ Implementing personalised calming techniques (e.g., familiar music, preferred scents)

10. Staff Training & Support

☐ Staff trained in dementia care approaches (e.g., Positive Behaviour Support, Dementia Care Mapping)
☐ Regular debriefing and review of behaviour management strategies
☐ Staff awareness of individual preferences, triggers, and calming techniques for each resident
☐ Ensuring consistency of approach across different staff members

Final Considerations Before Referral

☐ Has the behaviour been tracked over time (ABC charts, behaviour logs)?
☐ Has a multidisciplinary review been conducted (OT, SLT, physiotherapy, dietitian)?
☐ Has the family been involved in discussions and interventions?
☐ Is referral to Psychiatry of Later Life the most appropriate step at this time?