GSA experts propose strategies to address dementia-related psychosis

A new white paper from The Gerontological Society of America (GSA) highlights the variety of challenges that persons with dementia-related psychosis and their caregivers have encountered during moves through different health care settings -- and proposes strategies to address these challenges.

It is estimated that over 2 million Americans with dementia experience delusions (false beliefs) and hallucinations (seeing or hearing things that others do not see or hear). This group of symptoms, known as dementia-related psychosis, frequently goes undetected in people who may be struggling with other complex behavioral and psychological symptoms of dementia.

The white paper, "Dementia-Related Psychosis: Strategies to Address Barriers to Care Across Settings," was developed by a clinical workgroup of experts whose membership reflects multiple areas of expertise, including primary care, neurology, psychiatry, and nursing. It follows a 2019 GSA publication, "Dementia-Related Psychosis: Gaps and Opportunities for Improving Quality of Care."

When left untreated, the hallucinations and delusions that frequently occur in patients with dementia can cause significant patient and caregiver distress and often lead to institutionalization. There is a pressing need for greater awareness of the condition and more effective diagnostic and treatment strategies."

Gary W. Small, MD, Chairperson, FGSA

Small is the chair of psychiatry at Hackensack University Medical Center and the physician in chief of behavioral health at Hackensack Meridian Health.

According to the white paper, psychosis in dementia is associated with an increased risk of recurrent hospitalization and the need for more restrictive levels of care. Better care of individuals with dementia-related psychosis requires new initiatives and advocacy at several levels.

"Primary care needs full support to be able to better identify and care for these patients, both in terms of education about dementia-related psychosis and its management, and also by providing enhanced access to expert and specialty care, particularly for providers in rural communities," said Alexis Eastman, MD, who also served on the workgroup. "We need to not only formalize and expand the education of trainees and providers on this disease, but enhance care coordination opportunities through collaborative models and telehealth platforms -- to ensure that providers not only have understanding of dementia-related psychosis, but the resources to adequately care for these patients."

Eastman is the medical director in the Division of Geriatrics at UW Hospitals and Clinics and an assistant professor at the University of Wisconsin School of Medicine and Public Health.

The white paper indicates that because patients with dementia-related psychosis who transition across settings of care may be at risk for worsening symptoms, such transitions should occur only when mandatory and be carefully managed by health care professionals who have experience specific to the care of persons with dementia.

In long-term care settings, team-based approaches to care and additional education for staff, as well as surveyors, could help enhance resident quality of life and support guideline-based care.