Posted: June 27th, 2015

Alzheimer’s

PICO Question: Alzheimer’s
Title of Article: Nonpharmacological Management of Agitated Behaviours Associated with Dementia
Authors/Researchers: Dorothy A Forbes, RN, PhD; Shelley Peacock, RN, MN; Debra Morgan, RN, PhD
Citation: Forbes, A. D., Peacock, S., Morgan, D., (2005). Nonpharmacological Management of Agitated Behaviours Associated with Dementia. Medscape Geriatrics Aging. 8(4):26-30.
Level of Research Evidence (Hierarchy): randomized controlled trials.

What is the problem, need, or hypothesis (What are the researchers trying to find out?)

There are many strategies used in the management of physical nonaggression, verbal nonaggression, verbal aggression, and physical aggression in older patients suffering from dementia. There have been few studies conducted on randomized controlled trials. The purpose of this study is to investigate the effectiveness of various interventions used in dementia management such as, bright light, music, massage, validation, pet and simulated presence therapies. The absence of strong evidence in relation to these interventions might be an illustration of the lack of rigor in the formulation of previous studies rather than the lack of effectiveness of the strategies. This study seeks to identify which interventions are most effective in treating symptoms of agitation related with the different varieties of dementia and at diverse stages of cognitive impairment (Forbes, Peacock & Morgan, 2005).

What did the researchers do?  (What is the methodology of the study?)

The researchers used two theoretical models which conceptualize behavioral distress related with dementia. The two models are reduced stress-threshold framework and unmet psychosocial needs framework. Strategies aimed at dealing with psychosocial unmet wants of those suffering from dementia such as sensory deprivation, loneliness and boredom, offer social contacts, activities, and sensory stimulation. The reduced stress-threshold framework holds that individuals with dementia gradually lose their managing abilities and view their environment as progressively more stressful. Simultaneously their stress threshold falls, developing into anxiety and conduct disturbances. Strategies based on this framework aim to minimize stimulation and encourage relaxation. Strategies included in this study are classified according to these frameworks (Forbes, Peacock & Morgan, 2005).

What do the findings or the results mean?  (What does it indicate?)

            Some of the studies carried out in this such revealed the significance of personalizing intervention measures such as simulated presence, music and multisensory stimulation to coincide with the patients preferences, level of cognition, cultural and individual backgrounds. However, it is not clear which strategies and at what concentration, duration, scheduling and frequency should be directed at which type and phase of dementia. Whether the objective of the intervention is to offer stimulation, social contact or activities based on the unmet psychosocial framework or to offer relaxation based on the reduced stress-threshold framework? All the strategies examine the incidence and/or the severity of the disconcerted behavior. This means that future investigations should also evaluate the efficacy of the strategies from the viewpoints of the patients with dementia in conjunction with their formal and informal care providers. Improved correlation of the interventions with the patient’s needs, preferences and abilities may generate more benefits to patients with ADRD and their care providers (Forbes, Peacock & Morgan, 2005).

What are the study limitations?  (Are there biases in the study?)

            It is significant to note that during the study that about five respondents refused to respond to audiotapes used in simulated presence therapy. This occurred more than 50% of the time, which accentuates the importance of formulating the interventions to particular individuals. During simulated presence therapy, audio tapes ought not to be offered to patients who might be too disturbed to attend to the simulation or family members who do not have strong relationships with the patients should not appear in the audiotapes. The second limitation of this study is the relatively small sample population selected for the study. The sample population is so small that the findings can not be generalized to the whole population. This means that further randomized controlled trials should be carried out which will include a population sample proportional to the general population (Forbes, Peacock & Morgan, 2005).

What is its impact in OT practice?  Is it relevant and applicable to OT patient care?

            Several interventions such as pet therapy, validation therapy, therapeutic touch, simulated presence, multisensory stimulation, and aromatherapy have illustrated promising outcomes in reducing physical nonaggression, verbal nonaggression, physical aggression and verbal aggression. This means that more efforts should be put in place to carry out more studies to generate stronger evidence on the effectiveness of these interventions (Forbes, Peacock & Morgan, 2005).

References

Forbes, A. D., Peacock, S., Morgan, D., (2005). Nonpharmacological Management of Agitated Behaviours Associated with Dementia. Medscape Geriatrics Aging. 8(4):26-30.