New hope for dementia patients through Bethany Community's 'Awakenings' program

• Awakenings

Ralph Sanders, 74, participates in Bethany Community’s Awakenings program. He has experienced dramatic results, according to Ralph and his wife, Alice.

Talk about it

It is a fearsome predator, robbing simple moments of everyday living from its victims. Memories are stolen, personalities altered, often replaced with a thick web of confusion and anxiety.

For years, many dementia patients living in care centers faced a spiraling path over which they had little control.

But that path is changing through a new approach under way at Alexandria’s Bethany Community nursing home.

The traditional treatment for patients with dementia or Alzheimer’s disease is evolving. Programs like Bethany’s “Awakenings” offer new promise for a higher quality of life for those afflicted with the symptom.

Instead of treating dementia like a condition that needs to be quieted with antipsychotic medications, Bethany and 14 other Ecumen care centers across Minnesota are participating in the Awakenings program, which aims to reduce the usage of antipsychotic and antidepressant medications for dementia patients, when possible.

The program is funded through a $3.8 million grant from the state of Minnesota. It was first piloted in Two Harbors at Ecumen Scenic Shores in 2009.

THE PROGRAM

The Awakenings program officially began at Bethany in October 2010. About 40 people are currently enrolled at the facility.

Carol Kvidt, executive director at Bethany, estimates about 80 percent of those living in Bethany’s care center have a form of dementia.

Antipsychotic drugs are often prescribed for individuals with dementia who are exhibiting combative behaviors like punching or shouting, according to Kristi Saffert, LPN, project lead for the program at Bethany. The medications help to calm them.

They also often change behaviors in other ways, however.

“[The medications] dull the senses,” Kvidt said. “That is really not appropriate.”

Kvidt explained that reducing the doses of medications helped patients become more alert, enabling them to participate more fully in other activities.

When an individual starts the program, medications are usually reduced right away in a “planned approach,” according to Kvidt. “If it is going to work, it shows a benefit quickly and then they just keep working with it.”

The other prong of the program involves taking an assessment of the resident, learning about his or her life history and discovering interests, such as music.

Exercise is another key component to the program. Bethany offers exercise machines for patients to use daily.

Patients become involved in many one-to-one activities like puzzles, discussion groups or games.

“It seems so commonsensical,” Kvidt said. “The better we know the resident, the better we can care for them.”

Each patient has an individualized treatment plan and various intervention techniques are employed, including reminiscing about people and finding ways to pique patients’ interests to guide them away from repetitive conversations and thoughts.

It is also important for patients to receive constant familial support. Visits are encouraged and staff provides family members with informal training.

Some residents will continue taking the medications because they provide a benefit.

IMPROVED LIVES

Kvidt has noticed many positive changes.

“Once you start feeling better, you get motivated to do more. Your energy comes back,” she said.

For example, a patient that usually would have to rely on an aide to help him get dressed is now able to do it on his own.

“The more that they are able to do for themselves, the longer they stay independent,” Kvidt said.

Kvidt told the story of a woman with dementia who had not spoken in years.

“One night, the staff helped her call her daughter,” Kvidt said. “The daughter cried and said, ‘That’s the first conversation I’ve had with my mother in years.’ When they hung up, [the patient] reached back for the phone like she didn’t want it to be over. She knew she was talking to her daughter. That’s powerful. And so the next time she had an opportunity, she called the other daughter.”

And residents seem to like taking part in the exercise program, socializing and other activities.

RALPH AND ALICE

Ralph and Alice Sanders have been married 23 years. They met as church pen pals, mailing letters back and forth between Ohio and Minnesota.

The couple lived with Ralph’s mental illness, dementia and associated behavioral issues for many years. He was taking antipsychotic medications when he moved to Bethany Community in March.

“He’s had a long, horrible life as far as his behavioral problems,” Alice said. “He has been through shock treatments twice.”

“I was down,” Ralph, 74, said. “I’ve improved since I’ve been here.”

Kvidt remembered what it was like when he first came to Bethany.

“It didn’t start out so well, though,” she said.

Ralph said, “No, ma’am. I was a little bit stubborn. I didn’t want to do anything at all. I have so much to be thankful for – for this program. It has really helped to improve me.”

Alice concurred.

“When he was first here, he was belligerent, agitated – refused to do anything,” Alice said. “Refused to exercise – just angry.”

Things have changed dramatically since Ralph started Awakenings.

“I go to everything,” he said.

Exercise is an important part of the program for him. He works out several times a day in his wheelchair, using the rails in the hallway and using the equipment.

He is participating more in community activities and enjoys “chewing the fat” with other residents when they meet for coffee.

“He has turned completely around since when he got here,” Alice said. “He has been the best he’s been for a long, long time. I am very happy.”

COST AND SAVINGS

Kvidt acknowledged that while the program has many benefits for patients, it has an added cost in the increased staffing needed to fully implement it.

With the money provided through the state grant, Bethany was able to add staff from 7 a.m. to 7 p.m., seven days a week and train them for dementia interventions.

But an upside may outweigh the staffing costs. A savings will be realized in the long run because costly medications will no longer be administered, Kvidt said.

“If the state would see fabulous outcomes and save a whole bunch of money, maybe they would see the value of putting their money into people, hours and time versus paying med[ication] bills,” she said. “That is what we’re hoping to show.”

THE FUTURE

After the three-year grant money is used, Kvidt predicts the changes made through the Awakenings program will have become a part of the Bethany “culture.”

The next focus for the program will be to work with people experiencing depression.

“It is fun to see people that typically have not been involved in activities come out and socialize and get more active,” she said. “Those [exercise] machines used to sit there. Now, it’s like the Y in the morning. They are laughing and they socialize.”

Antipsychotic medications in nursing homes

“Even though antipsychotics are meant for use with residents diagnosed with mental illness, more than half are prescribed to control dementia-related behaviors where there is no mental illness diagnosis. For some people with dementia, antipsychotics play a helpful role, but for many others they significantly decrease quality of life…” according to Ecumen’s website.

“Even though statistics vary from state to state, up to 45 percent of nursing home residents receive antipsychotic drugs. In Minnesota alone, it’s estimated there are at least 27,000 nursing home residents on such medication. These drugs carry many risks for the elderly. Residents often experience tremors, drowsiness, sluggishness, and impaired mobility that reduce their quality of life. In addition, antipsychotics increase risk for strokes, pneumonia, and serious adverse drug events leading to hospitalization or even death. These drugs carry a Food and Drug Administration black-box warning that elderly patients who use them have an increased risk of death.”

Ecumen’s website: www.ecumen.org

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