The New York City Chapter of the Alzheimer’s Association is introducing a new program into select assisted living facilities and nursing homes that offers more palliative treatments and less psychotropic medications. This
new program called Comfort First™believes that patients exhibiting aggressive behavior are probably reacting to pain and should be treated with pain killers rather than sedatives. The program, developed by the Beatitudes Campus in Phoenix Arizona concentrates on making Alzheimer’s and other types of dementia patients more comfortable. This program is being introduced throughout the country with considerable success.
For years, the medical community concentrated on treating “troubled” dementia patients with medication. Patients exhibiting “unacceptable” behavior such as hitting or yelling were given psychotropic medications to make them more manageable. Unfortunately, this often did not treat the underlying cause of the behavior and increased the risk of falls and injury because the medication caused increased confusion and unsteadiness.
Comfort First™ focuses on relieving pain and alleviating aggressive and agitated behavior. Based on the realization that there is no cure for Alzheimer’s disease, the plan concentrates on making these patients feel comfortable rather than concentrating on medical interventions. “Quality of life” rather than “Quantity of Life” is the goal. Comfort care, also known as palliative care is a “softer” approach to treating patients. The concept is based on core principles:
*Recognize and meet all the needs of the individual with dementia, including their social, spiritual and emotional needs as well as their medical and physical needs.
*Identify and alleviate the reason for the patient’s discomfort, particularly pain, hunger, or fear.
*Apply practices that comfort residents in later stages of the disease, such as food available around the clock, small-group or one-on-one rather than large group activities, and adjustments in the facility’s routine to accommodate the patient’s preferred sleep pattern.
*Address the resident’s emotional distress rather than masking it through sedatives.
*Reduce aggressive and cure-focused medical treatments for residents with late-stage dementia.
Many Alzheimer’s patients become combative particularly late in the day around the time the sun goes down. This behavior is called sun downing. For years the common approach for treating this undesirable behavior was offering sedatives. This stops the patient from hurting himself.
Comfort First™ believes that this negative behavior or agitation is often a reaction to anxiety, unexpressed fear, pain, fatigue or boredom. Actions should be taken to understand the cause of the behavior. If the reason for the fear or anxiety can be addressed, the person can often be made calmer without medical intervention. Through Comfort First™, staff members are trained to understand the patient’s behavior and identify verbal and non-verbal indicators of pain and treat it with appropriate pain medication.
I remember the case of a client I will call Ms. Taylor who was being cared for in the dementia wing of a senior care residence. She was in the mid stages of Alzheimer’s disease. Before she had retired Ms. Taylor worked in an office most of her adult life.
Every day about 5 p.m. Ms. Taylor began pacing in front of an elevator mumbling to herself. If you tried to take her away from the elevator she would lash out at you both physically and verbally, which made her a difficult patient to attend to. However if you listened to her mumbling, you would hear that she was worried because she needed to go home and fix dinner for her children.
Applying the principles of Comfort First™, a staff member would talk to Ms. Taylor and assure her that her children had called the office and wanted her to know that they were fine. They would then stay with Ms. Taylor until she calmed down, then diverted her to another activity.
Comfort First™ also believes that pain is a reason for aggressive behavior. Many patients with Alzheimer’s disease often suffer from other medical problem such as arthritis, chronic pain, constipation, heartburn or dental pain. These patients are unable to verbally communicate physical discomfort and commonly act it out with anger, anxiety, aggression and/or combativeness.
In the late stages of dementia other problems develop. Not only does this disease affect memory, it begins to cause difficulty with walking, balance, swallowing and finally breathing. As the disease progresses, the body begins to shut down. Often family members do not understand that this is a natural process. They worry that their loved one is “starving” and when trouble eating and swallowing occurs, they choose tube feedings to insure they get proper nutrition. This procedure is often painful and is not always tolerated by the dementia patient who might pull on the tube causing trauma to the abdominal wall.
Under Comfort First™ patients are offered their favorite foods whenever they want. The food is often soft tasty foods such as chocolate ice cream or puddings. The idea is to offer the patient the pleasure of tasting and smelling rather than worrying about restrictive diets. .
The Alzheimer’s Association, New York City Chapter has launched a program to educate and implement this new approach in nursing homes in the metropolitan area. It is being implemented in three area nursing homes at this time: Isabella, in Washington Heights, Jewish Home and Hospital on the Upper West Side, and Cobble Hill Health Center here in Brooklyn. The Visiting Nurse Service of New York Hospice & Palliative Care, Metropolitan Jewish Hospice &Palliative Care and Calvary Hospice Care are also participating.
“This program has the potential to significantly improve care for the person with moderate to advanced dementia, and improve the lives of their family caregivers, and the staff who are caring for them.” said Jed A. Levine, Executive Vice President of the New York City Chapter.
This person-centered approach is working wonders in nursing homes, residential facilities, and even in the home. It is a way of offering Alzheimer’s patients more respect and dignity, treating them as people who desire to spend their final years in a comfortable and loving environment.
If you are concerned about a person with memory loss, call the Alzheimer’s Association, NYC Chapter 24 Hour Helpline for free information, support and guidance. 1 800 272 3900 or visit their helpful website at alz.org/nyc.
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