Advances in the treatment of psychiatric disorders in long-term care homes.
OBJECTIVE
Psychiatric disorders are common among older adults in long-term care (LTC) homes and the LTC population is rapidly growing in many countries. Treatment of psychiatric conditions in this population is challenging given the psychosocial environment and physical frailty of the population. This review highlights some important advances in pharmacological and nonpharmacological interventions in this setting.


RESULTS
There is some evidence to support the use of psychosocial interventions for behavioral symptoms, including those utilizing sensory interventions such as aromatherapy and calming music; behavioral management techniques; cognitive stimulation; physical activity; and staff training. There is also some evidence to support the use of psychotherapies such as reminiscence therapy and cognitive behavior therapy for depression. Recent literature on the pharmacological management of behavioral symptoms of dementia have included studies of the antipsychotic aripiprazole, prazosin, and medication-discontinuation trials along with two negative studies involving melatonin and oxcarbazepine.


CONCLUSIONS
The literature on psychosocial interventions for behavioral symptoms associated with dementia has been criticized for lack of vigor, but there is growing evidence from studies with improved methodology that these interventions may confer significant benefits, although the effect sizes are often small or moderate. More well designed trials of pharmacological therapies in the LTC population are also necessary.
Conn
David K
DK
Department of Psychiatry, Baycrest Centre & University of Toronto, Toronto, Canada. dconn@baycrest.org
Seitz
Dallas P
DP
D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001521:Behavior Therapy; D003704:Dementia / Q000188:drug therapy / Q000628:therapy; D006707:Homes for the Aged; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy / Q000628:therapy*; D009735:Nursing Homes; D012944:Social Support
D000927:Anticonvulsants; D014150:Antipsychotic Agents