benzodiazepines , such as Ativan , which are associated with an increased risk of falls and , thus , fractures ; and Celexa and other such antidepressants that have limited data supporting their effectiveness in easing dementia symptoms .
DICE is a mnemonic for Describe , Investigate , Create , and Evaluate , the four pillars of this approach . At its core is an assumption people with dementia engage in disturbing behaviors for often-unrecognized reasons that can be addressed once they are understood .
An example given on the website is Jennifer , a 55-year-old caregiver for her mother , Betty , 85 , whom she tries to bathe daily in the late afternoon . When Betty resists getting into the tub , Jennifer insists , “ Let ’ s go ! I have things to do .” Betty responds by smacking her and shouting , “ Leave me alone . It hurts .”
DICE asks caregivers to step back from the heat of the moment and examine issues from three perspectives : The person with dementia , the caregiver and the environment . All can contribute to distressing situations and all need to be considered in fashioning a response .
Examining the problem by using a “ who , what , when , how , why ” prompt can reveal several potential issues :
• The patient . Betty has arthritis and may experience pain getting in and out of the tub . She may feel tired and overwhelmed in the late afternoon .
• The caregiver . Jennifer may become easily frustrated when she encounters resistance — adopting a scolding and commanding tone rather than breaking down what Betty needs to do in simple steps .
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When people think about dementia , they usually think about forgetfulness and memory impairment . But it ’ s behavioral and psychological disturbances that are most disruptive to patients ’ and caregivers ’ lives . ˮ
MARY BLAZEK
• The environment . The bathroom tends to be cold , with overly bright lights , tepid bathwater , and no grab bars around the tub .
Some possible solutions are discussed on the website : Offer Betty an over-the-counter pain reliever before her bath ; try baths in the morning , not the afternoon ; relax expectations that she ’ ll have a daily bath and offer sponge baths several times a week ; install grab bars around the tub and make sure the water temperature is comfortable ; use a nicely scented soap and play music to help Betty relax ; and speak calmly , making simple statements .
Recognizing and addressing underlying medical issues such as pain , infections or delirium , simplifying the tasks a person with dementia is expected to perform and establishing daily routines to provide structure , are recognized as strategies that improve neuropsychiatric symptoms associated with dementia .
Other important steps include : Engaging the person in activities that are meaningful to them , including social interactions ; reducing clutter and the potential for overstimulation in the environment ; making sure the person is using hearing or vision aids , if needed ; and getting them outside and exposed to light .
If safety , psychosis , or major depression are urgent concerns , then caregivers consider using psychoactive medications after consulting a physician .
However , this isn ’ t a comprehensive list of recommendations . Nor is it prescriptive . What works for one person with dementia may not work for another .
Using DICE is an iterative process that involves creativity and frequent evaluation to assess whether strategies are working , Kales said . If not , new interventions should be tried .
Although this is the first time family caregivers can access the DICE toolkit , the program has been available to health care professionals for a while . Notably , all of Wisconsin ’ s dementia care specialists have been trained in DICE over the past few years ( every county in that state has a specialist who helps families with dementia ).
“ It ’ s a really pragmatic approach that ’ s put together in a very thoughtful fashion ,” said Art Walaszek , a professor of psychiatry and medicine at the University of Wisconsin School of Medicine and Public Health who ’ s been involved in that effort .
Other dementia training programs are available , some of which review behavioral and psychiatric symptoms in less depth , and they , too , are increasingly available online . Another resource , Best Programs for Caregiving , launched in March , lists evidence-based programs across the country and their availability .
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