“So we asked ourselves why? Why are we using antipsychotic medications at these kinds of levels? Some people would say well it must be because of the BPSDs (Behavioural and Psychological Symptoms of Dementia) that are associated with Alzheimer’s disease. But then we have to ask ourselves what is the reason for the BPSDs? Some people will say well the BPSDs are caused by the Alzheimer’s disease. But it’s not as simple as that. The disease is a predisposing factor, but it’s not the main cause.
So what is the main cause? Well, what we notice in long-term care facilities is that people are bored, and when people are bored, they find things to do, but the things they find to do are not always the things that fit with what the staff would like. Let me give you an example. I might get a call from somebody who says to me “Philippe, we have a case like you’ve never seen before, we have a man who has pulled the sink from the wall.” And I answer, “that sounds to me like a man that has a lot of potential: he’s focused, he had to be focused on the task to do what he did. He still has a lot of strength, he’s in good physical shape, what he did was impressive, so we’re going to be able to engage him in some way.” And then they go on to tell me: “Oh but Philippe, come and see down the corridor. He ripped all the tiles out with his fingers. “Determined!” I say back to them.
So what happens is that, like this man, people get bored. They may have worked all their lives as manual labourers, and when they feel bored, they go back to doing what they know how to do. And then sometimes they go into other people’s bedrooms and when they do that, they get involved in altercations with other residents, they are labelled as having behavioural issues, and then what do we do? We medicate them. It’s as simple as that.
You might roll your eyes and say “oh well Philippe you’re oversimplifying things by attributing this behaviour to boredom. But the work of Dr. Cohen-Mansfield who has been researching BPSDs for decades and is an authority on the subject, clearly identifies the main causes of BPSDs: boredom, lack of stimulation, lack of activity, being uncomfortable, and pain. It’s not rocket science. There are many things we can do to change the situation. And I can tell you with certainty that antipsychotics are not effective in treating boredom.”
- Une autre version en anglais.
- Another English version of this story.
- Autres postes avec Philippe Voyer.
- Forum sur les meilleures pratiques en CHSLD
M. Philippe Voyer, Ph.D, est professeur titulaire, directeur du programme de 1er cycle et responsable de la formation continue à la Faculté des sciences infirmières de l’Université Laval. Il voit à l’élaboration et la prestation des cours touchant les soins infirmiers aux aînés et à la pratique infirmière avancée dans les soins gériatriques.