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Technique called DICE empowers caregivers, patients & health providers to work together to reduce behavioral problems ANN ARBOR, Mich. - A new approach to handling agitation, aggression and other unwanted behaviors by people with dementia may help reduce the use of antipsychotics and other psychiatric drugs in this population, and make life easier for them and their caregivers, a team of experts says. [caption id="attachment_1845" align="alignright" width="300"]

• D: Describe - Asking the caregiver, and the patient if possible, to describe the "who, what, when and where" of situations where problem behaviors occur and the physical and social context for them. Caregivers could take notes about the situations that led to behavior issues, to share with health professionals during visits.
• I: Investigate - Having the health provider look into all the aspects of the patient's health, dementia symptoms, current medications and sleep habits, that might be combining with physical, social and caregiver-related factors to produce the behavior.
• C: Create - Working together, the patient's caregiver and health providers develop a plan to prevent and respond to behavioral issues in the patient, including everything from changing the patient's activities and environment, to educating and supporting the caregiver.
• E: Evaluate - Giving the provider responsibility for assessing how well the plan is being followed and how it's working, or what might need to be changed.

The authors say that doctors should prescribe psychotropic drugs only after they and the patient and caregiver have made significant efforts to change dementia patients' behavior through environmental modifications and other interventions, with three exceptions related to severe depression, psychosis or aggression that present risk to the patient or others. Now, the authors say, health providers of all kinds who care for dementia patients should familiarize themselves with the DICE approach - as should the spouses, adult children and others who care for dementia patients at home. "Innovative approaches are needed to support and train the front-line providers for the burgeoning older population with behavioral symptoms of dementia," says Kales, a professor in the U-M Medical School's Department of Psychiatry and member of the U-M Institute for Healthcare Policy & Innovation. "We believe that the DICE approach offers clinicians an evidence-informed structured clinical reasoning process that can be integrated into diverse practice settings." Gitlin, who directs the Center for Innovative Care in Aging at the Johns Hopkins School of Nursing, adds, "The DICE approach is inherently patient- and caregiver-centered because the concerns of individuals with dementia and their caregivers are integral to each step of the process. DICE also enables clinicians to consider the roles of nonpharmacologic, medical and pharmacologic treatments concurrently." Lyketsos, chair of the Department of Psychiatry at Johns Hopkins Bayview, stresses that the approach "has tremendous utility in clinical trials of treatments for behavioral symptoms, particularly in testing new medications. DICE can be used to better subtype behaviors, or focus on particular behaviors at randomization coupled with systematic treatment approaches'. Reference: Journal of the American Geriatrics Society, Volume 62, Issue 4, pp 762-769, April 2014 Learn more about the U-M Program for Positive Aging, including its resources for health care providers to assist with management of behavioral aspects of dementia. Link to original UMHS press release here.