Drs. Kolanowski, Resnick, Beck, and Grady highlight a number of contributions of geriatric nurse scientists to the care of older adults. The specific example of nonpharmacological interventions for the treatment of behavioral and psychological symptoms of dementia (BPSD) provides evidence that nursing research can fill an important gap in our understanding of a complex, challenging public health issue.
Across the country, people who live in nursing homes, their families, and nursing home caregivers are faced with symptoms of this disease that put people at risk for many adverse events, as outlined by the authors. These behaviors may affect not only the individual person but others in the environment as well. To address this issue, the Centers for Medicare & Medicaid Services (CMS) has launched the National Partnership to Improve Dementia Care. While led by CMS, this partnership began years ago through efforts by consumer organizations, provider groups, and various government agencies. These groups wondered why CMS was not doing more to improve the lives of people with dementia who live in nursing homes, and they were particularly concerned about the high percentage of people with dementia who receive antipsychotic drugs (nearly one in four, based on 2011 CMS Minimum Data Set data).
Through a dynamic, ongoing partnership with multiple state and federal agencies, professional associations, advocates, family members, and others, CMS and its partners are working in every state to reduce unnecessary antipsychotic drug use and promote effective, nonpharmacological interventions for the care of people with dementia. Clinicians, nursing home providers, and advocates are trying to move away from a “culture of prescribing” for people with dementia, which arose, in part, from a desire to improve distressing symptoms and behaviors and because a paucity of research (until now) had left us without strong evidence for many viable alternatives.
The good news highlighted in the commentary is that nursing and other disciplines have begun to build a body of research that provides evidence for the effectiveness of nonpharmacological interventions in preventing or reducing BPSD. Promoting a person-centered care approach—such as getting to know someone with dementia as a person and working with families or caregivers to understand a person’s usual daily routines, care preferences, lifelong interests, food preferences, and other basic assessments—can provide meaningful data. Building trust and developing close resident-caregiver relationships through consistent assignments, nursing homes are implementing interventions to reduce or eliminate BPSD in many cases.
This is still a young science, and much work remains to be done. Nurses and professionals from other disciplines are conducting implementation studies and translational research that are helping to inform the public policy discussion. We must continue to build research, enhance practice, and promote training, as well as collaborate to develop thoughtful public policy to improve the lives of people with dementia living in nursing homes.