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Director of Nursing Brings New Approaches to Care for Patients with Alzheimers or Dementia
Adeline (Abby) Bovee, Director of Nursing at the Finger Lakes Center for Living (FLCL), is successfully finding new approaches to improve the quality of life for residents with Alzheimers or dementia. She has been so successful, in fact, that she has been invited to present her findings at the annual conference for Directors of Nursing sponsored by the New York State Association of Homes & Services for the Aging (NYAHSA) in November, 2009.
“The message I will share is that there is a better way to deal with behaviors such as yelling, climbing, or being unable to sit still,” she said. “Traditionally, antipsychotic medications have been used to assist in controlling many of these behaviors. But at FLCL we have shown that even when residents are unable to communicate the problems that lead to these behaviors, we can learn a great deal by looking at their personal histories, and find alternative treatments.”
As part of a study funded by the Alzheimer’s Association which provided 55 nursing homes from around the country with access to dementia-specific quality measures and benchmarks, Abby built a team made up of physicians, pharmacists, FLCL staff and families who worked together in studying the residents who had Alzheimers or dementia. “In the late 90s, the FDA stated that using antipsychotic drugs with dementia patients is often inappropriate and may actually hasten their death,” she said. “We wanted to change the culture. We looked at each patient’s diagnosis. If the medication was appropriate, we did not change the regime. But in many cases we saw good results by gradually reducing the medication and initiating alternative treatments.”
As an example, Abby cited a gentleman who had been yelling, falling, constantly going into other people’s rooms and who never seemed to be comfortable. “While we reduced his antipsychotic medication, we looked at his history,” she said. “He had been a Post Office employee. So we tried saving piles of junk mail and asking him to sort it for us. This had a good effect in controlling his behavior while enabling him to enjoy his life.”
There are many other alternative treatments, including simply giving a resident increased one-on-one time with staff while decreasing medication. “A common complaint from nursing homes is that they don’t have the staff or the time for one-on-one attention,” she said. “But FLCL is a relatively small nursing home with fewer resources than many larger facilities, and we are showing it can be done. I believe that people who work in long term care have a commitment to the residents; they want to use what they know to improve their quality of life. If we can show them a better way, they will use it.”
Another resident Abby worked with had been an avid golfer. The staff provided him with golfing magazines and arranged for him to watch golf on television. This worked as a distraction from his agitated behaviors without the use of medication.
“When we reduce the doses of medication, we find that residents have a better appetite, are more alert, often begin feeding themselves for the first time in years – these are huge gains,” said Abby.
The FLCL team has also been working on new ways to deal with pain suffered by residents who cannot explain what is hurting them. “We look at physical conditions they have which might be painful, such as arthritis, injuries from a past accident, damaged disks, etc. The behaviors that result can range from agitation to kicking off shoes to moaning. Sometimes just starting a patient on ibuprofen can reduce those behaviors and improve their quality of life. We just need to anticipate what might cause pain and treat it, and then assess the results by checking whether specific behaviors change.”
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