The initial management of NCS in 3 steps
Step 1: Address potential triggers identified in the assessment. For example;
- Commence regular analgesia
- Stop inappropriate medications
- Manage constipation
- Treat any infections
- Give communication tips to carers, e.g. use short simple sentences, avoid confronting or correcting the person unnecessarily, limit choice to minimise confusion
Step 2: Introduce a personalised intervention
- Music: ask family members to make up tapes of songs that the person used to like or tapes of family member talking
- Social interaction: suggest that a carer spends 10-15 minutes a day with the person reminiscing or having a conversation about a topic of interest to the individual. This will give significant benefit. A life storybook is a good way of identifying the conversation and themes for reminiscence.
- Increase day-time activity where possible this relieves boredom and improves nighttime sleep.
- Aromatherapy: There is some modest evidence to support the use of lavender aromatherapy oils to decrease agitation
Step 3: Observation
- Observe the person for a period of time 1-4 weeks, if no improvement reassess for delirium/ triggers.
How to decide on whether to commence pharmacological treatment in NCS in 3 steps
Step 1: Stop and Think: Is it warranted?
- Is this symptom or behaviour of sufficient severity or impact to warrant medication?
Step 2: Stop and Think: Will it help?
- If you have established that it warrants treatment the next step is to consider if this is a behaviour or symptom that will respond to medication.
- Behaviours or symptoms that are unlikely to respond to medication include; wandering, inappropriate undressing, repetitive questioning, hiding & hoarding.
Step 3: Identify the symptom cluster
- Identify the main cluster of symptoms and target your treatment to that cluster.
- The pharmacological option chosen depends on the behaviour(s)/symptom(s) you are trying to treat. There is no “one size fits all” blanket treatment for NCS
- Examples of potential symptom clusters & the possible treatments are:
- Anxiety/ Agitation: may respond to an SSRI
- Agitation/Sleep Wake Cycle disturbance: may benefit from Trazadone in addition to sleep hygiene techniques
- Aggression/Psychosis: if severe and risk to self or others consider antipsychotic - please review our information on antipsychotic prescribing.