Remembering Your Roots: The Role of Horticulture Therapy in People Living with Dementia

Introduction: Dementia is a debilitating disease affecting over 50 million people. Major challenges facing patients with dementia lie in the impact of the behavioral and psychological symptoms of dementia (BPSD). The American Geriatrics Society and Dementia Action Alliance recommend against the use of antipsychotics as first-line treatment. Antipsychotics often fail to treat BPSD whereas nonmedication practices such as horticulture therapy may lessen BPSD. Guideline evidence has provided a unique opportunity for public health officials to assist in filling this vital role in the approach to BPSD management.Methods: Several studies and meta-analyses were reviewed to determine the effectiveness of horticulture therapy in managing BPSD, and evidence supports horticulture therapy as an effective method of addressing BPSD.Results: The benefits of horticulture therapy extend beyond addressing only BPSD; through multisensory stimulation, patients have increased physical activity, reduced stress, and improved sleep. Horticulture therapy has been shown to decrease the sense of loss and reestablish the patient in a familiar nurturing role, providing the patient with a sense of purpose.Conclusion: Stakeholders within the public health sector are strategically positioned to implement evidence-based interventions that address the unmet needs for the care of dementia within the community

Pain Management in Dementia Patients in Nursing Homes

Pain in the elderly, especially those with dementia, is often undertreated and misdiagnosed by health care professionals in the long-term care setting. Communication barriers in patients with cognitive impairment force pain assessment to rely heavily on subjective interpretation of behavioral factors due to the inability of patients to self-report pain symptoms. It is important for clinicians to develop a standard method of identifying and assessing signs of pain in patients with dementia in order to appropriately treat those experiencing discomfort. Patients with dementia who present with a sudden onset of behavioral changes should receive a comprehensive evaluation that includes a patient questionnaire, standardized pain assessment scale, an observational method of assessment and family member or caregiver interviewing to assess if these changes in behavior could be a result of undiagnosed pain. Proper differential diagnosis of symptom presentation is the only way to ensure that cognitively impaired patients receive the correct diagnosis and treatment to resolve the underlying cause of symptomatology

Management of Breakthrough Pain in Cancer Patients: Traditional and Novel Approaches

Approximately 80 percent of career patients experience breakthrough pain (BTP) characterized by acute onset, short duration, and moderate-to-severe intensity. Treatment of BTP using current available medications is often insufficient, leading to the development of various novel approaches that focus on rapid onset of action and short duration of action. Most of these products are still in clinical trials, and future studies are needed to compare the novel approaches to currently available treatments. Non-medication related issues, which arise from a lack of communication and understanding between the patient, physician and pharmacist, are also barriers to adequate BTP management. By educating patients and working with physicians, pharmacists can play a major role in effectively managing cancer-related BTP