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Keeping calm with non-drug options for people with dementia

The Bottom Line

  • Close to 90% of people with dementia will experience agitation, a behavioural issue that negatively affects the health and lives of patients and their caregivers.   
  • Non-drug options such as massage therapy, personally tailored interventions, animal-assisted interventions, and pet robot interventions may help reduce agitation in adults with dementia by small to moderate amounts.  
  • Try adding a non-drug option to your agitation management toolkit. Consult a health care provider to help determine the most appropriate approach to use and how to best incorporate it into a treatment plan.  

For most of us, the first things we think of when it comes to dementia are the cognitive and functional declines associated with the condition. However, other aspects of dementia, such as aggression, agitation, anxiety, and psychosis (1-4), have a significant impact on the lives of patients and their caregivers.


In particular, agitation, which affects nearly 90% of dementia patients (5;6), obstructs a patient’s ability to engage in essential or desired activities, hinders relationships, decreases quality of life, and is even a factor in achieving admittance into nursing homes (7-10). For informal and formal caregivers, patient agitation also gives rise to feelings of powerlessness, stress, and poor health outcomes (1;11-13).


Given that medications used to treat agitation, such as anti-psychotics, are not highly effective and come with potentially serious risks, you may be wondering if non-drug options are an effective alternative (7;14). The answer based on a recent systematic review is…yes, some can be (5)!


What the research tells us 

The non-drug options assessed in this review include: massage therapy (e.g., hand or foot massages), interventions personally tailored to people’s abilities and interests, animal-assisted interventions (e.g., petting, brushing, and feeding a dog), pet robot interventions, light therapy, music therapy, reminiscence therapy, aromatherapy, physical exercise, dementia-care mapping, and horticultural therapy (i.e., related to plants and gardening). People engaging in these non-drug approaches were generally compared to people receiving usual care or a placebo (e.g., educational presentations, water sprays, etc.).


The results demonstrate that massage therapy may lead to moderate decreases in agitation among adults with dementia, compared to usual care or placebo, while personally tailored interventions, animal-assisted interventions, and pet robot interventions may bring about small decreases in agitation. Benefits were not seen with any of the other seven non-drug approaches evaluated (5). 

If you’re a person with dementia or a caregiver of someone with this condition and are struggling with agitation management, try adding a non-drug option to your treatment arsenal. With several approaches showing potential, there is more choice and a better chance of finding a strategy that works for you or your loved one. A health care provider can help with incorporating new approaches into your plan.


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References

  1. Jutkowitz E, Brasure M, Fuchs E, et al. Care-delivery interventions to manage agitation and aggression in dementia nursing home and assisted living residents: A systematic review and meta-analysis. J Am Geriatr Soc. 2016; 64(3):477-488. doi: 10.1111/jgs.13936.
  2. Trivedi D, Goodman C, Dickinson A, et al. A protocol for a systematic review of research on managing behavioural and psychological symptoms in dementia for community-dwelling older people: Evidence mapping and syntheses. Syst Rev. 2013; 2:1-9.
  3. Dementia Initiative. Dementia care: The quality Chasm 2013. [Internet] 2013. [cited December 2020]. Available from https://www.nursinghometoolkit.com/additionalresources/DementiaCare-TheQualityChasm-AWhitePaper.pdf
  4.  Lyketsos CG, Carrillo MC, Ryan JM, et al. Neuropsychiatric symptoms in Alzheimer’s disease. Alzheimers Dement. 2011; 7:532-539.
  5. Leng M, Zhao Y, Wang Z. Comparative efficacy of non-pharmacological interventions on agitation in people with dementia: A systematic review and Bayesian network meta-analysis. Int J Nurs Stud. 2020; 102:103489. doi: 10.1016/j.ijnurstu.2019.103489.
  6. van der Linde RM, Dening T, Stephan B, et al. Longitudinal course of behavioural and psychological symptoms of dementia: Systematic review. Br J Psychiatry. 2016; 209(5):366-377. doi: 10.1192/bjp.bp.114.148403.
  7. Livingston G, Kelly L, Lewis-Holmes E, et al. Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials. Br J Psychiatry. 2014; 205:436-442. doi: 10.1192/bjp.bp.113.141119.
  8. Wetzels RB, Zuidema SU, de Jonghe JFM, et al. Determinants of quality of life in nursing home residents with dementia. Dement Geriatr Cogn Disord. 2010; 29:189-197.
  9. Draper B, Snowdon J, Meares S, et al. Case-controlled study of nursing home residents referred for treatment of vocally disruptive behavior. Int Psychogeriatr. 2000; 12:333-344.
  10. Morris LW, Morris RG, Britton PG. The relationship between marital intimacy, perceived strain and depression in spouse caregivers of dementia sufferers. Br J Med Psychol. 1988; 61:231-236.
  11. Black W, Almeida OP. A systematic review of the association between the behavioral and psychological symptoms of dementia and burden of care. Int Psychogeriatr. 2004; 16:295-315.
  12. Ornstein K, Gaugler JE. The problem with “problem behaviors”: A systematic review of the association between individual patient behavioral and psychological symptoms and caregiver depression and burden within the dementia patient-caregiver dyad. Int Psychogeriatr. 2012; 24:1536-1552.
  13. Pinquart M, Sorensen S. Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: A meta-analysis. J Gerontol B Psychol Sci Soc Sci. 2003; 58B:112-128.
  14. Maher AR, Maglione M, Bagley S, et al. Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: A systematic review and meta-analysis. JAMA. 2011; 306:1359-1369.

DISCLAIMER: Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of these blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations such as social distancing and frequent hand washing. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with current social distancing recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.

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