Caring for older adults with dementia is stressful, especially when they become physically or verbally aggressive, wander away from home, develop paranoia or hallucinations, engage in inappropriate or repetitive behaviors, or refuse to let caregivers help them. <\/p>\n

Upward of 95% of patients experience these neuropsychiatric symptoms of dementia, which tend to fluctuate over time and vary in intensity. They\u2019re the primary reasons people with dementia end up in assisted living facilities or nursing homes. At some point, families and friends trying to help at home simply can\u2019t manage. <\/p>\n

\u201cWhen people think about dementia, they usually think about forgetfulness and memory impairment,\u201d said Mary Blazek, director of the geriatric psychiatry clinic at the University of Michigan. \u201cBut it\u2019s behavioral and psychological disturbances that are most disruptive to patients\u2019 and caregivers\u2019 lives.\u201d<\/p>\n

Now, help is available from a first-of-its-kind website<\/a> created by prominent experts in this field. It offers free training in a comprehensive approach to managing neuropsychiatric symptoms of dementia \u2014 a method known as DICE \u2014 based on several decades of scientific research as well as extensive clinical practice.<\/p>\n

The website\u2019s goal is to \u201cgive people tools to better manage often-distressing situations,\u201d said Helen Kales, chair of the Department of Psychiatry and Behavioral Sciences at UC Davis Health in Sacramento, California, and one of DICE\u2019s creators. Users learn that neuropsychiatric symptoms are caused by changes in the brain that increase people\u2019s vulnerability. Nine video modules and two simulations provide comprehensive information and problem-solving techniques.<\/p>\n

More than 16 million unpaid caregivers \u2014 primarily family members and friends \u2014 help people with dementia live at home. (An estimated 20% of patients live in institutional settings.) The most common form of dementia, Alzheimer\u2019s disease, affects nearly 7 million Americans 65 and older.<\/p>\n

DICE is also designed to help \u201cavoid the knee-jerk prescribing of psychoactive medications\u201d that have potentially serious side effects, Kales said. Several medical organizations recommend that non-pharmaceutical approaches to troublesome behaviors be tried before drug therapy, but, in practice, this doesn\u2019t routinely happen.<\/p>\n

Drugs prescribed for dementia include antipsychotic medications, such as Risperidone, which carry a black-box warning noting an increased risk of sooner-than-expected death in elderly patients; anticonvulsants, such as gabapentin, for which use has been on the rise despite concerns about safety; benzodiazepines, such as Ativan, which are associated with an increased risk of falls and, thus, fractures; and Celexa and other such antidepressants that have limited data supporting their effectiveness in easing dementia symptoms.<\/p>\n

DICE is a mnemonic \u2014 a pattern of letters meant to serve as a memory aid \u2014 that stands for Describe, Investigate, Create, and Evaluate, the four pillars of this approach. At its core is an assumption people with dementia engage in disturbing behaviors for often-unrecognized reasons that can be addressed once they are understood.<\/p>\n

Take an example on the website featuring Jennifer, a 55-year-old caregiver for her mother, Betty, 85, whom she tries to bathe daily in the late afternoon. When Betty resists getting into the tub, Jennifer insists, \u201cLet\u2019s go! I have things to do.\u201d Betty responds by smacking her and shouting, \u201cLeave me alone. It hurts.\u201d<\/p>\n

DICE asks caregivers to step back from the heat of the moment and examine issues from three perspectives: the person with dementia, the caregiver, and the environment. All can contribute to distressing situations and all need to be considered in fashioning a response.<\/p>\n

Examining the problem by using a \u201cwho, what, when, how, why\u201d prompt can reveal several potential issues:<\/p>\n

The patient.<\/strong> Betty has arthritis and may experience pain getting in and out of the tub. She may feel tired and overwhelmed in the late afternoon.<\/li>\n

The caregiver.<\/strong> Jennifer may become easily frustrated when she encounters resistance \u2014 adopting a scolding and commanding tone rather than breaking down what Betty needs to do in simple steps.<\/li>\n