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While We Await an Alzheimer’s Cure – Utilizing DICE Caregiving Strategies

While We Await an Alzheimer’s Cure – Utilizing DICE Caregiving Strategies

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Alzheimer’s Disease and our senior loved ones who have the disease again take center stage as we observe Alzheimer’s & Brain Awareness Month (ABAM) in June.

This is the time we help spread awareness about what it would mean to cure Alzheimer’s disease while continuing to provide caregiving insights for family members of seniors who are already afflicted.

With the near-term outlook giving no reason for optimism, without not only no cure but also very little hope of a good treatment, it is very important that we look towards research to see where we are headed.

There has been a great deal of research, not only into the cause of Alzheimer’s disease but also into what we can do to prevent it from occurring.

Prevention, of course, would be even better for family caregivers who are on the front lines caring for someone with dementia. In the meantime, what can we learn to help caregivers deal with every aspect of the disease, including behaviors which take over our loved ones?

There are new techniques to help caregivers reduce some of the problem behaviors associated with dementia.

DICE Method to Handle Agitation and Aggression

A new method published recently by a panel of experts in senior mental health may be one approach family caregivers can employ to successfully reduce agitation, aggression and other unwanted behaviors in people with dementia.

The creators feel that it could make life easier for those who care for people with dementia.

The DICE Method is an acronym which stands for describe, investigate, create and evaluate. Because utilization of this method has the potential to reduce anti-psychotic drug use in those with dementia, Medicare has added it to their toolkit for facilities.

Many people with dementia will, at one time or another, experience behaviors such as agitation, aggression, hallucinations and depression. These symptoms are very difficult for family caregivers to manage to the point that it could result in caregiver stress and facility placement for the senior with dementia.

The DICE method helps caregivers with approaches for intervention to reduce triggers and alter the environment to help reduce negative behaviors.

The Steps Involved

In order to implement this approach to behavior management, we need to understand about each step. Behavior is generally caused by a combination of social and physical factors as well as caregiver related factors.

D = Describe

Describe in as much detail as possible about the behavior using the 5 W’s. Where, when, what, why, and who should be observed and recorded. Is there a certain time of day, a particular place in the house, is something happening at that time, is it worse with others or alone, and can you determine a trigger point?

Anything that you see or connect to the behavior will help you handle it so take notes even if it might seem insignificant at the time. Being able to establish a pattern of behavior will definitely help.

I = Investigate

Get your senior loved one thoroughly evaluated by the health care team to ensure there are no physical causes for the behavior including pain, medications or infection.

Poor sleep and impaired vision or hearing can contribute to negative behaviors and should be treated and corrected.

C = Create

Working with the health care team, the caregiver can develop a plan using the data recorded that will help manage the behaviors. Interventions that will impact the causes of the behaviors so that it can be altered or avoided is part of this step.

Interventions include changing the environment and daily scheduled activities plus educating caregivers about behavior management.

E = Evaluate

Along the way, the interventions need to be evaluated to see if they are working or if new interventions are needed. Through education, caregivers will know how to update their actions to better manage behaviors.

Non-Pharmacological Approaches for Behavior Change

A goal of the DICE approach is to make the caregiving journey better for people dealing with dementia, prevent placement to facilities before necessary and prevent the use of anti-psychotic medications that could be harmful.

Modifications in the environment and the way family caregivers treat behaviors will improve the quality of life for those with dementia and their families. Because this approach is individualized to each person and their family, it is person and caregiver centered.

There are other treatment modalities to reduce behavior symptoms that have been studied with very mixed reviews about their true efficacy. These include:

  • Aromatherapy – using fragrant plant oils to calm and soothe persons with dementia. It could be helpful for sleep and to reduce agitation related to mood but not aggression.
  • Acupuncture – as yet research has not been completed about the benefits of using this Chinese method for behavior reduction.
  • Light Therapy – using bright lights to stimulate the natural circadian rhythm to then improve sleep habits or agitation has not been proven despite several studies.
  • Reminiscing – while discussion of past events and experiences known as reminiscing has been shown to improve mood and depression, it has not yet been shown to reduce problematic behaviors.
  • Simulated Presence Therapy – using pre-recorded audio tapes of family members talking about cherished memories from the person with dementia’s life in order to stimulate their happy memories to reduce behaviors.
  • Massage and Touch Therapy – hand massage and touch can be helpful to reduce anxiety and aggression. Also being used is expressive touch which communicates emotion in addition to the touch to show the person with dementia concern for their well-being.
  • Music Therapy – playing old songs or soothing songs can stimulate memory and connect with the person with dementia resulting in reduction in agitation over the short-term. One benefit of music was shown to include the caregiver’s mood which in turn altered caregiving.
  • Multi-sensory Stimulation – use of activities that stimulate all primary senses using lights, tactile objects, aroma and music usually in a defined space rather than a living room which helps with calming.
  • Animal Assisted Therapy – using pets to interact with the person with dementia. Reports suggest that pets helped the senior be more engaged and interactive in their environment.

Improving Lives of Seniors & Family Caregivers

Some of these interventions could be implemented as ways to keep your senior loved one with dementia engaged, active and free from boredom.

Being physically active throughout the day and well hydrated can also help prevent some agitated behavior.

Being physically comfortable, well rested and socially engaged can help many people with dementia avoid aggressive behaviors that make caregiving difficult.

How you react as a caregiver to the actions of the person with dementia will also help you control behaviors. If you remain calm, talk in a soothing voice and refrain from conflicts with your senior loved one, it may lessen negative behaviors.

Hopefully this will make better the lives of both seniors and family caregivers – – while we continue to offer hope and support to those working toward curing and preventing Alzheimer’s and other dementias.

4 Responses to While We Await an Alzheimer’s Cure – Utilizing DICE Caregiving Strategies

  1. How can i get my family to see mom is heading into alzheimers thy claim her nerves she thinks at times she elsewhere her live in is what she thinks is moma or daddy at her time she has been in these and the live in guy refuses to take her to get evaulated he demands us that he knows her he takes her every month as he calls for her monthly treatment cuz her copd but she calls us crying wantn my deseased dad to come get her from another state when she goes out like that he corrects her says im not yo moma your moma dead etc

    • Hi Paula, sorry to hear that everyone is not on the same page with regards to your mom’s situation. Has she been fully evaluated by a doctor or neurologist? Let the family confer with the doctor so that together you can provide her the best care! Good luck!

  2. Love the article. We already have a system like that in our Home Care Agency, Home Care Connections, in Washington State, and it is wonderful. We are licensed and certified through AlzBetter, the Dementia Care Experts. It seems to be the forerunner to DICE and is “right on” Home Care for Alzheimer’s patients and their families need the support, education and respite that we can give them through our AlzBetter patten pending program.
    Thanks for DICE with us.

    Linda Oliver

    • Thanks Linda, happy to hear that people are taking advantage of a system such as DICE to help caregivers and seniors! We need more communities and facilities to be dementia friendly with programs and initiatives that benefit everyone. Appreciate your sharing your facilities success!

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