In Pursuit of the Tipping Point

September 15, 2014
Laura Beck, The Eden Alternative

icon_dementia_beyond_drugsLast week, someone asked me to clarify some things about our Dementia Beyond Drugs training that made me realize that there are still some misconceptions floating around out there regarding the vision behind it.  I’d like to share some of my thoughts on this, while noting that Dr. Al Power, the award-winning author of the book by the same name, may have a few of his own.

For some folks, the expression “dementia beyond drugs” is perceived as an all or nothing proposition.  What the training really emphasizes is how to move beyond merely reacting to so-called “behaviors” and, instead, learn to identify and respond to the unmet needs that are likely their underlying cause. Gone unchecked, unmet needs lead to distress and subsequent medication use for those who live with dementia. Ultimately, then, the goal is to tackle the cause, not just treat the symptom.

Does this mean that all drugs are bad when it comes to supporting the needs of those who live with dementia?  As the daughter of two parents who lived with two different forms of dementia, I can clearly say “no.”  In both cases (Alzheimer’s disease with Dad, and Lewy Body dementia with Mom), optimization (not maximization) of pharmaceutical support was key to achieving balance.

Yet, we’ve all heard stories (and Dr. Power shares some eye-popping ones in his book) of lives compromised needlessly by a slew of unnecessary medications.  Fortunately, this reality is becoming more of a mainstream, regulatory concern. CMS’ National Partnership to Improve Dementia Care in Nursing Homes, for example, has advocated for reducing the prescription of antipsychotic medications, limiting use to only those cases that involve “a valid, clinical indication and a systematic process to evaluate each individual’s need.”

Specialized training, like Dementia Beyond Drugs, is really the only way to reach the tipping point needed to effectively reduce the use of antipsychotic medications by those who live with dementia.  Employee care partners require education that demonstrates practice-based, individualized approaches focused on improving overall well-being and facilitating growth and meaningful engagement.  Dr. Power’s “Experiential Model” reminds us that when communication, as most of us know it, isn’t possible, the human spirit finds a way to make its needs known.

Our job, as fellow human beings, is to heed this call… to reject any recourse that attempts to silence it pharmaceutically and make every effort to eek out the message behind challenging reactions or “behaviors.”  Doing so honors our common need to fulfill our sense of identity, security, connectedness, and autonomy, as well as our need to experience meaning, joy, and never-ending growth… whoever we may be.

5 Comments. Leave new

Well said Laura!

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Nice post, Laura. My comment is that psychotropic drugs can certainly calm an acute episode of distress, but they can never create well-being; nor can they supply any unmet need that may be fueling the distress in the first place. That’s why they are not a long-term solution, only a short-term intervention. And it doesn’t matter if we’re talking about antipsychotics or other psychotropic drugs used in the same way. But sometimes you are in a crisis situation and some sort of short-term intervention becomes necessary. I actually titled the book “Dementia Beyond Drugs” instead of “Dementia Without Drugs” exactly for the reasons Laura states (with credit to the late Dr. T. Franklin Williams for that suggestion).
Another point I will add–to push the envelope a bit further–is that the “unmet needs” model is also a bit limiting. Many personal expressions are not due to distress, but may simply represent common human expressions such as curiosity, agency, solitude, or seeking variety. We tend to pathologize every action we see as some sort of “behavior,” due to the person’s diagnosis of dementia, and often hold people to a higher standard than we hold ourselves. Not every personal expression needs an intervention, medication or otherwise!

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Thanks for sharing your thoughts, Laura! I so agree.

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