Tamara Backhouse is a senior research associate at the University of East Anglia. In this blog, she discusses her recent co-authored Age and Ageing paper on the use of non-pharmacological interventions for dementia-related behaviours in care homes.
Dementia-related behaviours such as, aggression, agitation, anxiety, wandering and delusions are common. They can be distressing for individuals with dementia and create challenges for those caring for them. Many care-home residents with dementia experience these behaviours frequently. Non-pharmacological interventions (such as, music therapy, animal-assisted therapy, massage and aromatherapy) have been recommended as first-line treatments for dementia-related behaviours. However little is known about the day-to-day use of these interventions in care homes. We explored if, and how, non-pharmacological interventions were being used in care homes to manage dementia-related behaviours.
Our qualitative study found that social interventions such as offering a cup of tea or a walk were used as first-line interventions for dementia-related behaviours. Care-home staff viewed these actions as ‘distraction’ techniques. Non-pharmacological interventions such as music therapy, reminiscence, animal-assisted therapy and cognitive stimulation were used in care homes, but not to manage behaviours. They were normally used as activities for all residents regardless of the presence of dementia or behaviours. Activities were being used to increase wellbeing and not viewed, or used, as a way to reduce or manage behaviours.
The study also identified some inequality in the inclusion of residents in activities. Residents with considerable physical or mental difficulties or those experiencing more severe dementia-related behaviours were less likely to be involved in activities. This was due to some staff members not knowing how to include them and being selective about who was invited to be involved. Some residents were also reluctant to take part in activities.
Our findings suggest care-home staff are working hard to engage residents and improve their wellbeing. Individualised social interventions are being used in the moment as first-line treatments for dementia-related behaviours. However, non-pharmacological interventions such as those like music therapy, reminiscence, and pet therapy were used as activities and targeted at all residents to improve wellbeing. They are not being employed in care homes to manage behaviours. Even though activities were not viewed by staff, or used, as interventions for dementia-related behaviours, it is likely that the activities could have benefitted people with dementia and prevented instances of behaviour by improving the psychosocial environment.
We argue that further research is needed to assess the outcomes of individualised social interventions for dementia-related behaviours. There should be training and guidance for all care-home staff to increase understanding about which activities to use and when for people experiencing dementia–related behaviours. This would increase the knowledge about the role non-pharmacological interventions could have to manage behaviours. Lastly, action is needed to support the incorporation of non-pharmacological interventions into usual care practices so they can be used more easily in the moment as first-line treatments for dementia-related behaviours.