Person centered care reduces or eliminates the need for anti-psychotics

The CMS Partnership for Dementia Care is a wonderful opportunity to change the way we support persons living with dementia. Although affectionately called “The Anti-Psychotic Initiative” the Partnership speaks to so much more than reducing medications!
My involvement in the CMS Partnership began as a co-developer of CMS’ Hand in Hand with Karen Stobbe. Hand in Hand is a training toolkit that provides person-centered approaches to the care of persons with dementia and in the prevention of abuse. Hand in Hand connects the dots between person-centered dementia care and the reduction of anti-psychotics.  
It gives staff tools to meet the needs of persons with dementia in the spirit of relationship and understanding. This increased focus on anti-psychotics has given more attention to alternative “non-pharmacological interventions” as a response to the “behaviors” of persons with dementia. This is a move in the right direction because it acknowledges that medications, particularly antipsychotics, are not THE answer. It is clearly motivated by positive intent.
However, I suggest that we need to be careful about this term and to think more broadly of the opportunities to move towards person-centered dementia care. Here are 5 reasons why we need to move from “non-pharm interventions” to person-centered dementia care:

  1. “Non-pharmacological intervention”- these terms are generally medical. This perpetuates the idea that behaviors are purely medical problems and may limit us from looking at the reasons behind behaviors. “That person is ‘agitated’ because they have dementia- it’s just what happens.”
  2. In person-centered care “behaviors” of persons with dementia are considered a form of communication and an expression of need. Research shows us that what we see as behavior is largely the result of “incongruence between the needs of people who suffer from dementia and the degree to which their environment fulfills those needs”[1].
  3. The success of an “intervention” is typically measured by how well it reduces or stops the symptom (behavior). But we might overlook other important outcomes like meeting the needs of a person or enhancing quality of life.
  4. Interventions, while having value, do not transform the underlying experience, environment, or culture.
  5. We might fail to see the person, instead focusing on the disease and symptoms.

Person-centered dementia care includes values of honoring individuality, seeing persons as whole individuals, focusing on strengths, and seeing things from the lived experience of the person with dementia. It requires a change to individualized approaches as well as culture/system changes.

If we limit ourselves to focusing just on non-pharmacological interventions, we lose the opportunity to consider more broadly how we can create a person-centered culture of care and support in which persons with dementia have their varied yet individual needs met with meaning and purpose.

[1] J. Cohen-Mansfield, M. Dakheel-Ali, M.S. Marx et al.Efficacy of nonpharmacological interventions for agitation in advanced dementia: A randomized, placebo-controlled trial. J Clin Psychiatry, 73 (2012), pp. 1255–1261