From the Guidelines
The best approach to manage acute anxiety in a patient with dementia is to prioritize non-pharmacological interventions, focusing on creating a calm environment, identifying and addressing potential triggers, and utilizing behavioral techniques, with medication considered only when necessary. This approach is supported by recent evidence, including a 2023 study published in Ca-A Cancer Journal for Clinicians 1, which highlights the importance of person-centered care and psychosocial interventions in managing behavioral and psychological symptoms of dementia (BPSD), including anxiety.
Key non-pharmacological strategies include:
- Creating a calm environment by reducing noise and providing reassurance
- Identifying and addressing potential triggers such as pain, hunger, or need for toileting
- Utilizing behavioral techniques like distraction, reminiscence therapy, and familiar music
- Maintaining a regular schedule and routine to reduce boredom and confusion, as suggested in a 2021 study published in the International Journal of Nursing Studies 1
If medication is necessary, it's crucial to start with low doses and monitor closely, considering the potential risks associated with certain medications in dementia patients. For example, short-acting benzodiazepines like lorazepam or oxazepam may be considered, but their use should be cautious due to the increased risk of falls and potential worsening of cognition 1. Antipsychotics, such as risperidone, may be used for severe agitation but carry significant risks, including increased mortality in elderly patients with dementia, and should be used with caution and under close supervision.
Throughout any intervention, a person-centered approach is essential, involving familiar caregivers who understand the patient's preferences and routines, and regular reassessment is crucial to minimize medication use and adjust the approach as needed, given the vulnerability of dementia patients to medication side effects and their potential inability to communicate distress effectively 1.
From the Research
Treatment Approaches for Acute Anxiety in Patients with Dementia
- Non-pharmacological interventions are considered effective in reducing anxiety in people living with dementia, as evidenced by studies 2, 3, 4.
- Music therapy, in particular, has been shown to be a promising alternative intervention for the treatment of anxiety in patients with dementia, with significant reductions in anxiety symptoms and caregiver burden 2, 3.
- Other non-pharmacological interventions, such as exercise, aromatherapy, and massage, may also be effective in reducing anxiety symptoms, although the evidence is less robust 2, 3.
- Cognitive behavioural therapies (CBT) may also be effective in reducing depressive symptoms in people with dementia, although the evidence for their effectiveness in reducing anxiety symptoms is less certain 5.
- Pharmacological interventions, such as SSRI medications, may be considered for the treatment of anxiety in patients with dementia, although the evidence base is growing and further studies are needed to assess their efficacy and safety 6.
Key Considerations
- The choice of treatment approach should be individualized to the patient's specific needs and circumstances.
- Non-pharmacological interventions may be preferred due to their lower risk of adverse effects and potential for long-term benefits.
- Further research is needed to fully understand the effectiveness and safety of different treatment approaches for acute anxiety in patients with dementia, including the optimal duration and intensity of interventions 2, 3.