Recreation Therapy For Dementia

Introduction Patients/Residents residing in LTC homes with behavioral and psychological symptoms of dementia (BPSD) or (responsive behaviors) often receive treatment with antipsychotic medication to alleviate these symptoms as they are the standard of care (Borisovskaya, Pascualy, & Borson, 2014). BPSDs are often seen as challenging for staff working with the aging population and the use of antipsychotic medication is often used for the benefit of the staff and not for the benefit of the older adult. With an aging population and an increasing number of older adults in Canada a greater proportion of persons with dementia will follow. Based on projections using data from the Canadian Study of Health and Aging (Canadian Study of Health and Aging Working Group, 1994), the Alzheimer Society of Canada estimated that there would be 564 000 Canadians living with dementia in 2016. They also expected the number to rise to 937 000, an increase of 66% (Alzheimer Society of Canada, 2016). The Canadian Foundation of Healthcare Improvement (CIHI) in collaboration with interRAI created the RAI 2.0 indicator for appropriate use of antipsychotics, approximately 57% of all LTC facilities in Canada provide routinely collected and reported data to calculate this indicator (CIHI, 2018). Using the number of individuals who do not meet exclusion criteria and who are receiving an antipsychotic on 1 or more days within the 7 days preceding their most recent LTC assessment, divided by the total number of individuals in the facility or region (CIHI, 2018). The exclusion criteria for the RAI 2.0 indicator are individuals with schizophrenia, Huntington’s disease, those with active delusions or hallucinations, and those at the end of life (all potential indications for antipsychotics). heterogeneity in underlying clinical populations, differences in age, severity of dementia (as measured by the Cognitive Performance Scale), and agitation (HQO, 2015) require adjustments to be made to compare rates across facilities or regions (CIHI, 2018). Ontario, Alberta, British Columbia, and the Yukon, with partial reporting in Newfoundland, Nova Scotia, and Manitoba long term care facilities currently have provincial rates of the RAI 2.0 indicator publicly reported which creates a troubling discrepancy across jurisdictions concerning the use of antipsychotics in LTC facilities with patients/residents without a diagnosis of psychosis. CIHI using the RAI 2.0 indicator estimated that 27.5% of long term care patients/residents throughout Canada are prescribed antipsychotic medication without a diagnosis of psychosis (CIHI, 2018). If antipsychotic reduction programs were to be put in place nationwide it would benefit over 100,000 people every year and save $5.2 Billion healthcare dollars over the next 30 years (CFHI, 2018).There is an alternative for treatment for BPSDs in the form of non-pharmacological interventions which are strategies used for preventing, reducing or eliminating behaviors without the use or in conjunction with pharmaceutical agents based on the needs, preferences, and functional abilities of patients/residents residing in long term care facilities (Cohen-Mansfield, Libin, & Marx, 2007), (Janzen, Zecevic, Kloseck, & Orange, 2013).