Caring for individuals with dementia can be overwhelming, particularly when faced with challenging behaviors like aggression, wandering, paranoia, or hallucinations. These symptoms often lead to the placement of people with dementia into assisted living facilities or nursing homes. Recognizing the need for support, experts in the field have developed a groundbreaking website that provides free training in managing the neuropsychiatric symptoms of dementia.

The website, the first of its kind, aims to empower caregivers with effective tools to navigate distressing situations commonly encountered while caring for individuals with dementia. Developed by renowned experts in the field, the website offers comprehensive training in a method known as DICE (Describe, Investigate, Create, and Evaluate). This approach is based on decades of scientific research and extensive clinical practice.

According to Mary Blazek, the director of the geriatric psychiatry clinic at the University of Michigan, behavioral and psychological disturbances are the most disruptive aspects of dementia for both patients and caregivers. The DICE website addresses this by providing caregivers with a deep understanding of neuropsychiatric symptoms and problem-solving techniques through nine video modules and two simulations.

The need for such support is crucial, considering that over 95% of patients with dementia experience these symptoms, which can fluctuate in intensity over time. Currently, more than 16 million unpaid caregivers, primarily family members and friends, assist people with dementia in living at home. Additionally, it is estimated that around 20% of patients reside in institutional settings, like assisted living facilities or nursing homes.

One key aspect of the DICE approach is its focus on avoiding the overuse of psychoactive medications, which can have serious side effects. Medical organizations recommend non-pharmaceutical approaches before considering drug therapy, but this practice is not commonly followed. Drugs prescribed for dementia, such as antipsychotics, anticonvulsants, benzodiazepines, and certain antidepressants, have associated risks and limited evidence of effectiveness in managing dementia symptoms.

DICE stands for Describe, Investigate, Create, and Evaluate - the four pillars of this approach. It assumes that people with dementia engage in disruptive behaviors for reasons that may go unnoticed, and which can be addressed once understood. Caregivers are prompted to examine issues from the perspectives of the person with dementia, the caregiver, and the environment to determine factors contributing to distressing situations.

For example, the website features a scenario where Jennifer, a caregiver for her mother, Betty, encounters resistance when trying to bathe her. Through the DICE approach, Jennifer is encouraged to consider potential issues such as Betty's arthritis and the discomfort she may experience during bathing, Jennifer's own frustration, and environmental factors like cold lighting and the absence of grab bars.

The website suggests strategies to address these potential issues, including offering pain relief before bathing, adjusting bathing time to the morning, establishing a routine that provides structure, installing grab bars, using scented soap, and playing relaxing music. These strategies have been shown to improve neuropsychiatric symptoms associated with dementia.

In addition to these strategies, DICE emphasizes the importance of engaging individuals with dementia in meaningful activities, reducing clutter and overstimulation in the environment, ensuring the use of hearing and vision aids if necessary, and promoting exposure to natural light.

While the DICE toolkit has been available for healthcare professionals for some time, the launch of the website now grants access to family caregivers. Currently, all dementia care specialists in Wisconsin have been trained in DICE, and efforts are being made to increase access to this innovative approach.

As Art Walaszek, a professor of psychiatry and medicine at the University of Wisconsin School of Medicine and Public Health, describes it, DICE offers a pragmatic and thoughtful approach to managing dementia symptoms. While other training programs exist, DICE's comprehensive and evidence-based focus sets it apart.

Other valuable resources, such as the Best Programs for Caregiving website, which lists evidence-based programs across the country, also offer support to caregivers.

The DICE website not only provides a much-needed source of guidance and training for caregivers, but it also helps reduce the reliance on potentially harmful medications. The iterative nature of the DICE approach encourages creativity and frequent evaluation to ensure the strategies implemented are effective.

As the number of individuals living with dementia continues to rise, innovative approaches such as DICE play a vital role in improving the lives of both patients and their caregivers.