Alzheimer's disease is the most common form of dementia, accounting for up to 80 percent of all cases. According to the National Institutes of Health, up to 5 million adults 65 and older may be affected by Alzheimer's. Depending on age at the time of onset, life expectancy is usually 8 to 10 years after symptoms appear. Death frequently is related to complications such as malnutrition or infectious illnesses.
Alzheimer's is not a normal part of the aging process, but the risk for developing the disorder increases with age. Alzheimer's is characterized by memory loss, difficulty recognizing people and problems with communication. Over time, the symptoms increase and people with Alzheimer's eventually will require extensive assistance with daily activities, such as dressing, eating and bathing. Behavioral and psychological symptoms of dementia may be present, including apathy, agitation, hallucinations, delusions and motor behaviors, such as pacing.
Currently, there is no cure for Alzheimer's; however, the U.S. Food and Drug Administration (FDA) has approved several medications that may slow the progression of symptoms and improve quality of life. While antipsychotic medications frequently have been used in nursing home to treat symptoms, the FDA has approved these medications only for use when treating specific mental illnesses, such as schizophrenia and bipolar disorder. In 2005, the FDA issued a black box warning noting an increased risk of death in older adults with dementia who take atypical antipsychotics. In 2008, the black box warning was expanded to include typical antipsychotic medications as well.
Antipsychotics are only appropriate for use in older adults with dementia in a small number of situations. Antipsychotic medications should be used only when clinically necessary to treat targeted behaviors that are causing harm or significant distress to the person or others, and should be used at the lowest possible dose for the shortest time possible. Non-pharmacological interventions and therapeutic approaches are considered first-line therapy for behavioral and psychological symptoms. The HHSC Appropriate Use of Antipsychotic Medication page has more information about antipsychotic medications and alternatives to their use in people with dementia.
HHSC Training Opportunities
Alzheimer's Disease and Dementia Care Training
HHSC began offering Alzheimer's Disease and Dementia Care Training in March 2015 to help front-line staff and health care professionals provide appropriate, competent and sensitive direct care and support to residents with dementia.
Modules covered in this training include:
- Intimacy and sexuality
- Abuse and neglect
- Diversity and cultural competency
- Spiritual care and end of life
- Activities of daily living
Texas OASIS: Dementia Training Academy
The OASIS Dementia Training Academy is still available. If you missed the OASIS Academy in your area and would like to schedule the training in your facility, contact the Quality Monitoring Program at QMP@hhsc.state.tx.us.
Texas OASIS: Dementia Training Academy focuses on dementia basics, including person-centered care; managing behaviors and alternatives to antipsychotic medications; assessments and care planning; sexuality in dementia; and cultural and socioeconomic considerations.
Each facility will receive a flash drive containing the OASIS curriculum, as well as the DVD “Bathing Without a Battle” that can be used to train staff members within the facility.
If you attended the OASIS Academy and would like additional training, email JointEd.Services@dads.state.tx.us.
The OASIS curriculum was developed by Dr. Susan Wehry and adapted to meet the unique needs of Texas nursing facilities. This flyer provides more information about the OASIS program, and how to request the training in your facility.
Virtual Dementia Tour®
The Virtual Dementia Tour, “Your Window into Their World,”® simulates the physical and mental challenges people with dementia face. This training allows caregivers to “experience” dementia for themselves by providing a tool that allows them to move from sympathy to empathy and better understand the behaviors and needs of their residents. People who experience this sensory training have a greater understanding of the realities of living with dementia.
This training is available across the state either through Joint Training opportunities or on-site at nursing homes. For more information, or to request a Virtual Dementia Tour in your facility, please email QMP@hhsc.state.tx.us.
Person Centered Thinking Training
Person-Centered Thinking Training is an interactive 2-day training, designed to provide nursing facility staff with the skills necessary to help residents maintain positive control over their lives.
Participants will be introduced to the core concept of Person-Centered Thinking Training: finding a balance between what’s “important to” and “important for” the people they serve. Participants will learn how to obtain a deeper understanding of the people they support and to organize this learning to inform their efforts to help people get the lives they value.
Person-centered practices are designed to assist in the alignment of service resources that give people access to the benefits of community living and ensure they receive services in a way that helps them achieve their individual goals and outcomes.
Participants will practice a set of discovery, management and everyday learning skills. At the end of the 2-day training, they will feel empowered to learn more about their residents and make important changes to their practice. These changes will provide residents with a more meaningful existence, greater satisfaction, and an overall improved quality of life. Caregivers themselves will benefit by gaining an enhanced understanding of and compassion for the individuals they serve, thereby finding greater job satisfaction.
Who should consider attending? All staff caring for individuals residing in nursing homes, especially staff supporting those who have dementia and/or individuals who have intellectual and developmental disabilities.
To schedule a Person Centered Thinking class, contact the Quality Monitoring Program (QMP) staff assigned to your facility, or email QMP@hhsc.state.tx.us.
Alzheimer's Disease and Dementia Care Resources
Resources Created by DADS
- Evidence-Based Best Practices — Dementia Care in Long-term Care (PDF)
- Antipsychotic Medication Questionnaire (PDF)
- Care Planning Dementia-Related Targeted Behaviors (PDF)
- Comparing Traditional and Person-Centered Models of Care (PDF)
- Nutrition Best Practices in Dementia Care
- Non-pharmacological Culture Change
- Non-pharmacological Culture Change (Handouts)
- Reducing Antipsychotic Medications Videos
- VN Educator Toolkit: Alzheimer's Disease and Dementia Module
Resources from Other Organizations
National Nursing Home Quality Improvement Campaign
- 2017 Alzheimer's Disease Facts and Figures (Video)
- Health Care Professionals and Alzheimer's
- Alzheimer's and Dementia Caregiver Center
- Personal Care
American Geriatrics Society
- American Geriatrics Society (AGS) Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults
Centers for Disease Control and Prevention
Centers for Medicare and Medicaid Services (CMS)
- Hand in Hand: A Training Series for Nursing Homes Toolkit
- Review of Care and Services for a Resident with Dementia (PDF)
- National Partnership to Improve Dementia Care in Nursing Homes
- Survey & Certification Letter 12-44-NH: “Hand in Hand: A Training Series for Nursing Homes,” on Person-Centered Care of Persons with Dementia and Prevention of Abuse (PDF)
- Survey & Certification Letter 13-02-NH: Clarification of Guidance Related to Medication Errors and Pharmacy Services (PDF)
- Survey & Certification Letter 13-34-ALL: Release of Mandatory Surveyor Training Program on Care of Persons with Dementia and Unnecessary Antipsychotic Medication Use-Release of Third Video (PDF)
- Survey & Certification Letter 13-35-NH: Dementia Care in Nursing Homes: Clarification to Appendix P State Operations Manual (SOM) and Appendix PP in the SOM for F309-Quality of Care and F329-Unnecessary Drugs (PDF)
- Survey & Certification Letter 14-19-NH: Interim Report on the CMS National Partnership to Improve Dementia Care in Nursing Homes: Q4 2011-Q1 2014 (PDF)
- Survey & Certification Letter 15-47-NH: Medication Related Adverse Events in Nursing Homes (PDF)
- Survey & Certification Letter 16-04-NH: Focused Dementia Care Survey Tools (PDF)
- Dementia Care Presentation — Improving Dementia Care and Reducing Unnecessary Antipsychotic Medications in Nursing Homes
Massachusetts Senior Care Foundation
Music & Memory
New Jersey Geriatric Education Center
- The Interprofessional Approach to Alzheimer's Disease and Dementia Care: A 5-module web based program (Note: Web site requires registration to access modules)
University of Iowa — Iowa Geriatric Education Center
- IA-ADAPT: Improving Antipsychotic Appropriateness in Dementia Patients (Note: To access this resource, you must first set up a free account.)
University of Michigan – Program for Positive Aging
- DICE is a comprehensive approach for managing challenging behaviors while reducing the use of antipsychotic medication