Non‐Pharmacologic management: Considerations for Family Caregivers

Abstract

AbstractBackgroundAgitation is a common symptom of dementia, estimated to occur in upwards of 30% of patients.1 Family caregivers are often the frontline when it comes to management of agitation given that many patients with dementia live at home, and often bear the brunt of caregiver burden. In spite of existing research, which non‐pharmacological interventions should be used when is unclear.MethodThis abstract describes the application of the IPA algorithm to the family‐caregiver setting.ResultThe current IPA algorithm for agitation emphasizes the importance of non‐pharmacological interventions integrated with pharmacological interventions and adapted in an iterative manner dependent on patient response. Data on non‐pharmacological interventions in the family caregiver setting, though sparse, suggest a couple of key themes. Most interventions, including analyses of data from social media platforms, Long Term Care data and clinical trial data emphasize the importance of patient engagement.2 Planning appropriate activities, problem‐solving and teaching communication skills is also paramount. Finally, modification of the environment, reminiscence and engagement with outside support networks is critical. Individualized approaches with multiple components and modified based on follow up are particularly effective. Review of clinical trial data in fact suggests effect sizes comparable to that achieved with medication without the concomitant side effects.2 Finally, interventions that focus on the well‐being of the caregiver and emphasize enhanced self‐efficacy are particularly important, given caregiver burden in family caregivers often exceeds that of professional caregivers. Studies have been limited by lack of standardization, small sample sizes and limited follow‐up.ConclusionFurther rigorous studies are required to establish which approaches are most effective in family caregivers and how they relate to pharmacological interventions, though data to date suggest interventions that work in other setting (such as Long Term Care) may be adaptable to the family setting.1. Carrarini C, Russo M, Dono F, et al. Agitation and Dementia: Prevention and Treatment Strategies in Acute and Chronic Conditions. Front Neurol 2021; 12: 644317.2. Brodaty H, Arasaratnam C. Meta‐analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. The American journal of psychiatry 2012; 169(9): 946‐53.