The Non- pharmacological Approach
Supporting human rights to dignity, self-fulfillment, participation, independence and care
Nonpharmacological approaches to dementia comprise behavioral, communication and creative interventions, supportive environmental design, and technological tools that engage people with dementia, support their abilities to particpate in society, improve their daily life and quality of life, and build on their creativity. Ultimately these interventions support their human right to dignity, self-fulfillment, participation, independence and care.
Nonpharmacological approaches to dementia are increasingly taking their place in care systems around the world, clearly contributing to quality of life and demonstrably reducing what are commonly called “problem behaviours” no matter where the person happens to be living or spending their day—at home, in a free-standing day program, in a residential group setting, in a nursing home, in a hospital or in an end of life hospice.
At the core of nonpharmacological treatment is the neuroscience that indicates much remains alive and vital in the brain of a person living with dementia. Many of the 100 billion neurons and hard wired abilities in people’s brains remain healthy and accessible for years living with dementia. This approach builds on these abilities.
Environmental, social and creative interventions activate these parts of the brain that enable someone living with dementia to connect more to life than is commonly assumed possible. Such interventions focus on individual interests, abilities, skills, disabilities and wishes more than on general demographic or patterned characteristics which remove the person him or herself from the care equation.
The stigma attached to dementia in most societies today is one result of generalizing about this group of people, not only because the public uses general symptoms and conditions to “label” people with dementia, but also because the person often uses this “information” to define him or herself—resulting in greater isolation, depression and apathy. Labeling often has iatrogenic effects that occur when care practices themselves lead to elevating the very “symptoms” the care giver intends to reduce.
Medical and nonpharmacological approaches are both inseparable parts of caring for people living with dementia—they are not in conflict. When professionals facing health situations feel they must make the distinction between those that require a medical model and those best served with nonpharmacological approaches, they force an either/or choice based on this false distinction. These two terms are not strictly opposites although conventional usage allows them to be considered such. Each model has its own distinct value and application in every conceivable health condition and illness: diabetes, HIV/aids, depression, mental illness, obesity, addiction, and so on. These illnesses and conditions are regularly treated with both medical and nonpharmacological approaches—more holistic, authentic and effective than employing only one approach—why not dementia?
People with diabetes are advised to exercise regularly to reduce their glucose levels and cut down their sugar intake as well as being prescribed insulin. Clearly, lifestyle changes, dietary restrictions and exercise are prescribed to combat today’s obesity epidemic, while some consider surgery and medications as well. All these approaches to care can be seen as part of a larger combined care model—more holistic, authentic and more effective than employing only one approach.
A new paradigm is needed that includes employing nonpharmacological interventions to reduce the symptoms of Alzheimer’s and related dementias with the fewest side effects rather than focusing only on a search for pharmacological agents to control these symptoms and on a cure. Instead of artificially setting up a confrontation between pharmacological and non-pharmacological treatments, defining a coordinated “umbrella” concept that includes and coordinates both approaches is likely to improve outcomes for all concerned. Such an umbrella concept supports “human needs” no matter what illness or set of symptoms is being treated and employs all health approaches, including the “medical” model, as long as the focus is on the person’s “personhood.”
Impacts that research shows are linked to nonpharmacological interventions tend to be in the realm of function, attitude, sense of self, sense of dignity, engagement, quality of life, sense of purpose, making choices, and so on. Some of these are prerequisite steps necessary to arrive at outcomes while others are actual outcomes leading to improved quality of life for people with dementia. The most comprehensive outcomes of all interventions—both pharmacological and nonpharmacological—are those which demonstrably represent basic human needs and rights: dignity, independence, participation, self fulfillment and care in all its senses.
