Environment is a Primary Nonpharmacologic Intervention to Reduce Agitation in Alzheimer Disease, Geriatric Psychiatrist Explains

According to George Grossberg, MD, a geriatric psychiatrist recognized for his research on treatment for neurocognitive disorders, reaching for medication first when a person with Alzheimer disease becomes agitated is a simple solution to a problem but certainly not always an appropriate or necessary one. In a recent interview with Patient Care,® Grossberg offered an example of using the patient's environment, or a change in that environment, as a first-line intervention to calm the behavior by reducing or eliminating a trigger. He explains in the short video above.

This transcript has been lightly edited for length and clarity.

Patient Care: Are there non-pharmacologic interventions that can be effective, or do they tend to be more effective in combination with medication?

George Grossberg, MD: So, I think there are a couple of important points about non-pharmacologic approaches, especially related to environmental triggers, which we should keep in mind.

Let me give you an example. I had a new patient whose family decided to move her to a skilled nursing facility. She’d been fairly calm and wasn’t causing any issues, but they placed her in a shared room with another patient who happened to be quite noisy. Soon enough, I received a call from the nursing staff saying my patient had become even noisier than her roommate. Naturally, they wanted a quick solution—medication, something immediate.

But I told them, 'Let’s pause for a moment and think this through. Is there a quieter room available or a roommate who might be less disruptive?' They found a quieter roommate for her, made the switch, and I didn’t get any more calls.

That’s a perfect example of a non-pharmacologic intervention that worked effectively because it addressed the environmental trigger specific to her situation.

George T Grossberg, MD, is the Samuel W. Fordyce professor and director of geriatric psychiatry in the department of psychiatry at Saint Louis University School of Medicine. He is a past president of the American Association for Geriatric Psychiatry and of the International Psychogeriatric Association. Grossberg's research focus includes behavioral symptoms in Alzheimer disease and novel therapies for neurocognitive disorders.