To Manage Dementia Well, Start With the Caregivers

Helen Kales, founder of the Program for Positive Aging at the University of Michigan, has developed a behavioral approach to dementia care that puts the caregiver first and emphasizes training and support for them as much as for the person with dementia, reports NPR . "We think about dementia as a problem with memory, but it's really behavioral," says Kales, who points to the limited effectiveness of psychiatric medications often prescribed to manage behavior in individuals diagnosed with dementia. "We realized we needed to do something different," Kales says. "We just can't train enough physicians to provide dementia care. Instead, we need to take the daily treatment and management of these individuals out of the hands of physicians and put it into the hands of the caregivers themselves." The trick seems to be training family caregivers to spot triggers of behavior and problem-solve around those triggers, to look for underlying causes, and then to creatively craft strategies, Kales says. Kales has developed DICE, an acronym representing the four main steps of the process: Describe a behavior, thinking about what happens and the context in which it occurs; Investigate its possible causes; Create and implement a plan to address the behavior; and Evaluate the results to determine what worked.