Book review: Dementia Practice Guidelines for Treating Disturbing Behaviors

The disturbing behaviors associated with dementia are a significant problem for older adults, their families, and their caregivers. By the year 2050, the incidence of dementia in the US is expected to climb to 14 million, according to the Alzheimer’s Association. The associated rise in disturbing behaviors will further affect the afflicted’s interpersonal relationships and quality of life, as well as opportunities to experience leisure. Dementia Practice Guidelines for Treating Disturbing Behaviors, a 400-page document, provides a long overdue systematic approach that will help recreational therapists treat these disturbing behaviors. The authors’ focus on the importance of including the best available evidence when formatting treatment decisions distinguishes this text from previous approaches to treatment in recreational therapy. The foundation of the dementia practice guidelines (DPG) is the merging of the Need-Driven DementiaCompromised Behavior (NDB) model and the Neurodevelopmental Sequencing Theory of Prescription (NDSP). The NDB model suggests that the disturbing behaviors of persons with dementia are not a symptom of the disease but rather an unmet need. The NDSP, developed by Buettner in the 1980s, is a comprehensive approach for treating the disturbing behaviors of frail older adults with dementia. While the Omnibus Budget Reconciliation Act of 1987 has long promoted a nonpharmacologic approach to treatment, little has been done to promote alternative treatment interventions. The DPG promotes recreational therapy as the first line of defense, ahead of prescribed psychoactive medication, with its negative side effects. The section on recreational therapy outlines the 10 steps in treating disturbing behaviors, referencing them with appendix materials such as behavior checklists, physician order forms, and evaluation materials. The tools provided in the appendices will ensure a place for the DPG on the practitioner’s desk. Also helpful is a chart of more than 80 protocols that can help the practitioner select the appropriate intervention based on factors such as behavior, stage, level of dementia, and research findings. The criteria for selecting an intervention to decrease a behavior illustrates the application of evidence-based practice. DPG’s literature review incorporates an evidencebased grading system that lets the reader determine the strength of the research. The reference section includes a key to inform the reader if the article is research, literature, national guidelines, or theory. The life work of two researchers, the DPG demonstrates a groundbreaking contribution not just to the therapeutic recreation profession but also to healthcare in general. The focus on evidence-based practice using a nonpharmological approach to treating disturbing behaviors for persons with dementia is an important one. As the authors note, there are many unanswered questions, and for that reason, Dementia Practice Guidelines for Treating Disturbing Behaviors may be considered a work in progress . . . but a very useful one.