To reduce the use of antipsychotic medications in long-term care settings, many dementia care providers are seeking alternatives approaches

By Pam McDonald

Changes in behavior caused by Alzheimer’s or other dementia can be the most upsetting and challenging aspect of the disease for caregivers. These changes can include irritability, anxiety, emotional distress, depression, verbal outbursts, physical aggression, and even hallucination or delusions.

Antipsychotic medication is often prescribed to lessen these “behavioral expressions,” but have many negative side effects, including gait and balance disturbance, falls, decrease in levels of cognition, diminished ability with activities of daily living, increased cardiovascular events (such as heart attack and stroke) and risk of death.

To reduce the use of antipsychotic medications in long-term care settings, many dementia care providers are seeking alternatives approaches. Current research is showing that It’s Never 2 Late (iN2L), a Senior Housing Forum Partner, computer technology fits the bill.

iN2L Introduced Into the Community

Since its founding in 1999, iN2L, a Senior Housing Forum partner, has urged creative uses of its picture-based, touch-screen interface technology that makes it possible for virtually anyone to use a computer with little frustration. Users simply “touch” their way to engaging, entertaining, educational, spiritual, and personalized content that is appropriate to their level of cognitive and physical ability. Accessing e-mail and web cams to connect with family and friends, enjoying mind-stimulating activities, and improving hand-eye coordination, older adults– even those who have never used a computer before – are engaging in activities adapted especially for them.

Goals of the Research

One research project is the brainchild of staff at Western Homes Communities, a not-for-profit provider of assisted living, continuing care retrirement communities and skilled nursing care. Their goal is twofold:

  1. to improve care and quality of life for residents, and
  2. to address the behavioral and psychological symptoms of dementia (BPSD) for dementia care residents in a non-pharmacological manner.

They speculated that by using technolgoy-based activities and engagement they could reduce the use of “as needed” or PRN antipsychotics.

After vetting a number of devices and programs, they selected four iN2L units with articulating arms for flexible screen positioning; a hand-held bike simulator; a flight simulator joystick; and music maker capabilities that also works with large-screen systems. Since the units are mobile, they could be placed in residents’ rooms, community rooms, the therapy gym, or available lounges.

Western Homes procured funding through the Iowa Department of Human Services with a Quality Improvement Initiative Grant and piloted their research at their Martin Mental Health Center, a skilled nursing facility in Cedar Falls, Iowa, where 11 of 48 residents with dementia diagnoses receive PRN antipsychotics to treat BPSD.

First Year Results

After some training of staff, as well as that of volunteers and family members, the Center began testing whether they could manage BPSD by redirecting residents with personalized content on iN2L. Immediate results were encouraging: 50% fewer residents required PRN antipsychotics and there was a reduction in the number of doses given.

Lessons Learned

According to the researchers, the primary lesson learned was that despite initial reluctance on the part of some residents, nearly all joined in when an approach was found that appealed specifically to that individual. Researchers also provided the following advice for others who might want to implement a similar program:

  • Try a number of approaches and a number of activities until the resident becomes engaged
  • Place primary focus on the interaction of the resident and their caregiver, including family. The technology helps support an organizational foundation for a relationship-centered approach to care
  • Involve all stakeholders early and communicate often
  • Provide training opportunities and instructional material for new staff and family members

For more information, visit or read about the journey of a mother and daughter with iN2L at Case Study: Involving Family with Technologies in Dementia Care.