The combination of different types of support, each tailored to the person and the situation is preferable to offering one type of support or a standard care package.
2. Healthcare professionals should be aware that many people with dementia can understand their diagnosis, receive information and be involved in decision making.
Psychosocial interventions for comorbid depression and/or anxiety
3. A care plan for people with dementia, including those with comorbid depression should be drawn up on the basis of the life history, social and family circumstances, and preferences (such as diet, sexuality and religion) of the person with dementia. Activities should be adjusted to ensure that they are achievable with the limitations the patient has.
4. Assess and monitor people with dementia for depressions and/or anxiety.
5. Non pharmacological interventions should be considered in decreasing comorbid agitation, depression and/or anxiety and should be tailored to the person’s preferences, skills and abilities. Monitor response and adapt the care plan as needed.
Behaviour that challenges
6. People with dementia who develop non-cognitive symptoms that cause them significant distress or who develop challenging behaviour should be offered an assessment at an early opportunity to establish the factors likely to generate, aggravate or improve such behaviour. The assessment should include the person’s physical health and behavioural and functional analysis conducted by professionals with specific skills, in conjunction with carers and care workers. The assessment should lead to an individually tailored care plan and the coordination of care should be documented and reviewed regularly. The frequency of the review should be agreed by the carers and staff involved and documented.
7. People with dementia and challenging behaviour should be treated with acceptance and respect during a psychiatric crisis involving delusions, panic attacks, hallucinations and aggressive behaviour. The feelings that cause the behaviour and distract the patient should be identified. Confirmation of delusions should be avoided. De-escalation strategies should be used in the handling of aggressive behaviour. Restraint should be avoided and only used as a last resort.
8. If there are unexplained changes in behaviour or signs of distress, assess for undetected pain, using an observational pain assessment tool if helpful.
9. In severe dementia, treat pain both pharmacologically and non-pharmacologically. Consider the person’s history and preferences when choosing non-pharmacological therapies.
Support for carers
10. Respite or short-break services should be available and include, for example, day-care, day and night sitting, adult placement and short-term and/or overnight residential care.
11. Assess and monitor carers of people with dementia for anxiety and/or depression, especially in cases of problematic behaviour. Social workers/nurses should anticipate and intervene, especially when caregivers experience symptoms of depression, to prevent overburdening.
12. Care plans for carers should include tailored interventions such as individual or group psycho-education and training courses about dementia, services and benefits, and dementia-care problem solving. The general practitioner and/or other professionals should inform the family and caregivers of the local situation.
Management and coordination of care
13. Care managers/coordinators should ensure that there is coordinated delivery of health and social care services, including a combined care plan, agreed by health and social services, that takes into account the changing needs of the person with dementia and the carers. A case manager, one or two assigned people who would maintain regular contact with the patient and the main caregiver should be involved in aiding patients with dementia and their caregivers.
15. Health and social care managers should ensure that all staff working with older people in the health, social care and voluntary sectors have access to dementia-care training (skill development) that is consistent with their roles and responsibilities. This should include comprehensive training on interventions that are effective for people with dementia.
16. Staff should show a validating, respectful attitude in working and communicating with people with dementia.
Principles of care
17. Identify specific needs, including those arising from:
- sensory impairment
- communication difficulties
- ill health
Last Updated: Thursday 08 October 2009