A new website aims to give more support to people caring for older adults who are living with dementia.
The online resource, the DICE Approach, offers free training in a comprehensive approach to managing neuropsychiatric symptoms of dementia.
DICE stands for Describe, Investigate, Create and Evaluate. The basic premise is to understand why people living with dementia engage in behaviors; once people are aware, they can respond more appropriately, creators of the method say.
“When people think about dementia, they usually think about forgetfulness and memory impairment,” Mary Blazek, MD, director of the geriatric psychiatry clinic at the University of Michigan, said in an article published by KFF. “But it’s behavioral and psychological disturbances that are most disruptive to patients’ and caregivers’ lives.”
The website’s goal is to “give people tools to better manage often-distressing situations,” Helen Kales, MD, chair of the Department of Psychiatry and Behavioral Sciences at UC Davis Health in Sacramento, California, and one of DICE’s creators, also said.
The site includes nine video modules and two simulations to give some 16 million unpaid caregivers to those with dementia practical problem-solving techniques so they’re equipped to handle neuropsychiatric symptoms.
One of the main goals of DICE is to “avoid the knee-jerk prescribing of psychoactive medications” that have potentially serious side effects, Kales said. Several medical organizations recommend that nonpharmaceutical approaches to troublesome behaviors before turning to medications, but people tend to turn to medications as a primary solution.
Drugs prescribed for dementia include antipsychotic medications such as risperidone, which is linked with an increased risk of sooner-than-expected death in older adults. Other drugs include anticonvulsants such as gabapentin, which has been met with concerns about safety. Benzodiazepines such as lorazepam (Ativan), are linked with a higher risk for falls and fractures. Limited data exist that antidepressants such as citalopram (Celexa) work for dementia symptoms.
At its core is an assumption people living with dementia engage in disturbing behaviors for often-unrecognized reasons that can be addressed once they are understood.
DICE asks caregivers to evaluate issues from three perspectives: the person living with dementia, the unpaid caregiver, and the environment. All can contribute to distressing situations and all need to be considered in coming up with a response.
This is the first time family caregivers can access the DICE toolkit, which has been used by healthcare workers for a while.
“It’s a really pragmatic approach that’s put together in a very thoughtful fashion,” Art Walaszek, MD, a professor of psychiatry and medicine at the University of Wisconsin School of Medicine and Public Health, also said.
