DICE: Non-drug Approach to Alzheimer's Management
Scientists from University of Michigan Medical School and Johns Hopkins University have now concluded that drugs like antipsychotics and antidepressants are not good options for people with dementia. They favor, instead, hands-on, non-drug approaches that caregivers can use to cope with the behavioral issues that often occur in people with dementia.
According to an article on Science Daily, "non-drug approaches should be the first choice for treating dementia patients' common symptoms such as irritability, agitation, depression, anxiety, sleep problems, aggression, apathy and delusions." This research was recently published in the British Medical Journal.
While the researchers frame their recommendations in a program that they call DICE, this shouldn't intimidate caregivers, many of whom already practice these methods regularly.
DICE is an acronym for Describe, Investigate, Evaluate, and Create
The DICE program recommends that caregivers - both professional and family - treat each person with dementia as an individual and also be aware that as symptoms change, approaches by caregivers should also change. DICE is a partnership between the physician, the patient and the caregiver.
Describe: When a caregiver is working with a physician who subscribes to the DICE approach, the doctor will ask the caregiver to describe situations where problem behaviors occur as well as the physical and social context for them.
Investigate: During this phase, the physician will consider a holistic approach to the person with dementia. How is his or her overall health? What are the dementia symptoms? What medications are being used? What physical and/or social conditions could be influencing behaviors? How does the caregiver respond to these behaviors?
Create: The next stage is for the physician, the caregiver and other care providers to work together to prevent or respond to behavioral issues by making changes in the environment and using a hands-on caregiving approach to soothe and calm.
Evaluate: The last stage is empowering the caregiver to be responsible for assessing how well the plan is working and/or what may need to be changed.
Existing drugs often cause problems
Pharmaceutical approaches to managing behaviors presented by people with Alzheimer's and other dementia have not worked well. In fact, as people age, negative medication side effects can overtake any positive effect a medication may have had when first prescribed.
First author of the study, Helen C. Kales, M.D., head of the U-M Program for Positive Aging at the University of Michigan Health System and investigator at the VA Center for Clinical Management Research tells Science Daily:
"The evidence for non-pharmaceutical approaches to the behavior problems often seen in dementia is better than the evidence for antipsychotics, and far better than for other classes of medication. The issue and the challenge is that our health care system has not incentivized training in alternatives to drug use, and there is little to no reimbursement for caregiver-based methods."
Some medications may be necessary
The use of antipsychotics have been decreased enormously over the last few years and, with the government's urging, physicians have been pressured to reduce or eliminate the use of these drugs for most dementia patients.
Even behaviors such as sundowning, which is generally described as agitation and anxiety toward the end of the day, have been addressed successfully with non-drug solutions.
While some people with dementia may need short term drug relief from anxiety or other issues, the smallest dose possible should be given for the shortest period of time.
It's good to see researchers validate what many caregivers have known all along. Hands-on care, lovingly given, validates the humanity of the individual with dementia. This treatment does far more than simply drug people into oblivion. It allows them to live.
Carol is a newspaper columnist and the author of Minding Our Elders: Caregivers Share Their Personal Stories. She runs award winning websites at www.mindingourelders.com andwww.mindingoureldersblogs.com. Follow Carol @mindingourelder and on Facebook: Minding Our Elders