Increasingly there's pressure to manage Behavioural and Psychological Symptoms of Dementia (BPSD) in ways other than just through antipsychotics. This is a good thing. I still maintain that antipsychotics can be part of the answer for some patients some of the time, but they're not a cure when used alone.
I'm blessed to be working with nursing staff who are exceptionally good at what they do. Which isn't diagnosis or medical stuff, it's nursing care. I've a lady in permanent care, through progression of her dementia. She has become increasingly vocal (shouting out) and wandersome. We have no antishouting pill. We have no antimoving pill.
I looked at her medication and stopped some of it, which made things better. Two months on, things have progressed and again the home's struggling to cope with her. My nursing colleague visited and tried to understand why this lady was shouting and moving. Hip pain from arthritis after nonunion of a fracture could be one factor. Constipation could be another. Disorientation, through diminished insight and a lack of appreciation of what's going on, could be a factor. Thirst sometimes seems to be.
As well as spending time divining why the behaviour unfolds and what it means, the nurse also undertook some interventions at frequent intervals within the care home. Aromatherapy. Hand massage. Doll therapy.
It's all worked.