Wisdom from the front lines: clinicians' descriptions of treating agitation in the nursing home, a pilot study

The management of behavior problems is one of the most difficult challenges a clinician must face when treating patients with dementia. This article presents a qualitative analysis of the responses of 7 nursing home physicians and 1 nurse practitioner to open-ended questions regarding their experiences in treating behavior problems in dementia with an emphasis on nonpharmalogical methods. This study serves to highlight both the issues encountered by those commonly asked to treat behavior problems in the nursing home, and the thoughtfulness and insight developed by some clinicians to address the problems. Several themes emerged from clinicians' responses. Some of the clinicians developed algorithms for treating behavior problems. Some of the clinicians were frustrated with the expectation that behavior problems would be effectively treated pharmacologically. The treatment of behavior problems was described as complex and requiring more time than is allocated by reimbursement systems. They also expressed the need for multiple systemic changes in order to improve treatment, and provided many examples of inadequate resources, including reimbursement, staff, activities, staff training, and management issues needed to improve treatment of behavior problems in nursing home residents. On the positive side, they reported a high level of satisfaction when treating behavior nonpharmacologically. The clinicians felt that with appropriate systemic change many behavior problems can be either prevented or treated effectively by nonpharmacological means.