Tailored activities to reduce neuropsychiatric behaviors in persons with dementia: Case report

Importance: Neuropsychiatric behaviors of persons with dementia, including agitation, aggression, and rejection of care, are almost universal; occur throughout the disease process; and have negative consequences for both persons with dementia and their caregivers. Nonpharmacological approaches are now recognized as first-line treatment to address these behaviors. One promising approach is activity tailored to the person’s interests, abilities, and physical and social environment. An evidence-based program, New Ways for Better Days: Tailoring Activities for Persons With Dementia and Their Caregivers (TAP), draws on occupational therapy principles (person–environment–occupation fit, activity analysis) to meaningfully engage persons with dementia. Objective: This case report describes the TAP protocol and clinical reasoning processes underlying use of tailored activities as a therapeutic modality to address dementia-related neuropsychiatric behaviors. Design: This is a case study of an African-American woman in her 60s caring for her father, age 92, who has severe dementia and multiple behaviors. Outcomes and Measures: Primary outcomes in this case report include the person with dementia’s engagement in an activity and the reported neuropsychiatric behaviors. In addition, the caregiver’s confidence in using activities is reported. These and other measures from the TAP protocol are described in full. Results: After working with an occupational therapist for eight sessions, the person with dementia’s engagement in activity increased by 50% and his frequency of vocal disturbance decreased, and the caregiver felt more confident in using activities with her father. Conclusion and Relevance: This case report illustrates how occupational therapists working with families of persons with dementia can use the TAP protocol to help them manage neuropsychiatric behaviors by tailoring activities. What This Article Adds: Occupational therapists are uniquely qualified to systematically assess the cognitive functioning of persons with dementia, caregivers, and home environments and to integrate this information to derive and implement activities tailored to the person’s capacities and context, thereby reducing neuropsychiatric behaviors and increasing engagement in meaningful activity.