Nonpharmacological Treatment of Psychosis in Older Adults
A therapeutic relationship built on trust and mutual respect with the advanced practice registered nurse is one of the most important interventions for working with older adults.
For individuals presenting with signs/symptoms of possible psychoses, addressing triggers and potential underlying physical causes is the first step in formulating the most accurate diagnosis.
Once a diagnosis is determined, it is imperative that an individualized, person-centered plan of care is developed. Individualization includes the person’s values, goals, wishes, cultural identity, and diagnosis. Using both nonpharmacologic and pharmacologic interventions is prudent.
Nonpharmacological interventions (NPIs) are those that do not involve drugs or medications of any type, including oral over-the-counter and herbal remedies, and are psycho-social-spiritual in nature. Agitation, aggression, disruption, shadowing, depression, and repetitive behaviors can be improved with use of NPIs (Brodaty & Arasaratnam, 2012).
Promoting mild daily physical activity, appropriate nutritional intake, music therapy, aromatherapy, reminiscence and life review, meaningful individualized activities (independently or in a group setting), and a consistent/routine schedule can decrease psychotic symptoms (Blevins, 2018; Chen et al., 2014; de Oliveira et al., 2015; Gerdner, 2012).
NPIs are generally the first approach to psychosis unless the individual is a danger to self or others. In many cases, a combination of NPIs with pharmacological intervention are best for the individual.
Linda J. Keilman, DNP, GNP-BC, FAANP
Blevins, C.L. (2018). Optimizing care for older adults with dementia-associated psychosis. The Journal for Nurse Practitioners, 14(3), 178-182.
Brodaty, H., & Arasaratnam, C. (2012). Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. American Journal of Psychiatry, 169(9), 946-953.
Chen, R., Liu, C., Lin, M., Peng, L., Chen, L., Liu, L., & Chen, L. (2014). Non-pharmacological treatment reducing not only behavioral symptoms, but also psychotic symptoms of older adults with dementia: A prospective cohort study in Taiwan. Geriatrics & Gerontology International, 14(2), 440-446
de Oliveira, A.M., Radanovic, M., de Mello, P.C., Buchair, P.C., Vizzotto, A.D., Celestino, D. L., … Forlenza, O.V. (2015). Nonpharmacological interventions to reduce behavioral and psychological symptoms of dementia: A systematic review. BioMed Research International. doi:10.1155/2015/218980
Gerdner, L. A. (2012). Individualized music for dementia: Evolution and application of evidence-based protocol. World Journal of Psychiatry, 2(2), 26-32.
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