How to maximize programming to avoid medication use in dementia care

By: Rachael Wonderlin

Dementia care consultant and author of Dementia By Day.

Thomas was certainly not my “easiest” resident for whom to provide care. He was incredibly anxious: so anxious, in fact, that it was nearly impossible to get him to sit down and enjoy a program or activity. “I have to go!” he’d cry out. “I have to pick up my daughter from school!”

There were times it was difficult to get Thomas to even eat a meal sitting down. “I have somewhere to go,” he’d insist, getting up to leave the table.

After speaking with his daughter, we learned that Thomas loved art. He had been an avid painter for most of his life, and she attested that this often calmed him down.

We picked out some canvases and set up paints around the table for my residents. Knowing Thomas wasn’t much for sitting for explanations of activities, we waited until we’d gotten our other residents started with the painting program. “Hey, Thomas, can you come help me? I heard you’re a great painter and we could really use some new artwork for the walls in here.”

By asking for help, we were able to convince Thomas to take a chance on the program. He came to the table, sat, and picked up the paintbrush.

The team was happy to find that this occupied him for nearly 45 minutes—just about the longest we’d ever seen him sit.

Music has long been used as a tool for working with people living with dementia. Music has been found to reduce anxiety, to encourage interaction, to reduce agitation and to increase cooperation in persons with dementia.

Often, though, individuals who are in programming and director roles in senior living can get stuck in old ways of thinking about programming. Days become filled with Bingo games and program directors lean on “what they’ve always done” instead of looking for new ideas or new ways of approaching people that have been labeled as “challenging.”

Medication is an old method for solving problems. Before we dive into talking about how dangerous psychotropic medications are for the older adult population, however, it’s important to offer this caveat: medication exists for a reason. There are people living with dementia who can only benefit from programming once they had taken anti-anxiety medication. For some people, like Thomas mentioned above, there were times when medication was the first step. Many people in the field are anti-medication—for good reason—but some residents truly need anti-anxiety and anti-depression medication to be able to function at all. It’s awful to watch someone be so anxious that they can’t even sit down.

So how can we help program directors help their residents?

Directors need to know what exciting, innovative programming really looks like. Innovative programming is about looking at your residents and finding what makes them tick: who are they as people? What did they do in their daily lives? How can we incorporate that into a program? Companies like Relish (previously Active Minds) provide fun, pre-planned activities for people living with dementia.
Use music as a tool. As we know, music can help people living with dementia connect with their past and reminiscing is a great way to engage with residents. Personalized music lists can help people reconnect to they world around them (Cohen, Post, Lo, Lombardo, & Pfeffer, 2018).
Staff at the community need to understand what “behaviors” actually means. Often, staff get upset about dementia-related challenges like a resident taking another resident’s slippers, or a person who hoards items in their room. These are simply typical, dementia-related challenges. They aren’t anything we need to fix.
Residents who need medication should get it, but only after the community has tried other methods. Directors should ask themselves, “Have we tried everything?” Think of programs like Relish and programs like Eversound. Eversound’s latest product is awesome: they actually provide residents with the ability to tune into live experiences. This is something residents (and team leaders) are sorely missing at the moment, thanks to COVID. Even when COVID ends, cost is always a factor, so bringing in multiple performers every month often becomes a budget issue. With Eversound’s activity programming, residents can watch and engage in elevated, exclusive content on-demand.

While we can’t completely avoid medication use, we can help communities lessen their reliance on antipsychotics and other psychotropic meds. Creative programming and access to therapeutic solutions are simple, often-overlooked way to do just that.