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Responding to safety issues in frontotemporal dementias

From the School of Nursing (Dr. Talerico), Oregon Health Sciences University, Portland; and the School of Nursing (Dr. Evans), University of Pennsylvania, Philadelphia.

Address correspondence and reprint requests to Dr. Karen Amann Talerico, School of Nursing, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Mail Code: SN-ORD, Portland, OR 97201; e-mail: talerico{at}ohsu.edu

As frontotemporal dementia progresses in individuals, safety issues related to behaviors and injury become a paramount concern. In addition to self-care deficits, frontotemporal dementias are often characterized by behavioral manifestations that include aggression and disinhibition. These behaviors may place the patient and caregivers at risk of injury, stress, and social embarrassment, and frequently lead to institutionalization. Additionally, motor disturbances associated with frontotemporal dementias may contribute to risk of injury from falls. The authors present an integrated biopsychosocial model to guide assessment of needs that may be expressed through behavior. Environmental, behavioral, and psychosocial strategies to assist caregivers in preventing and responding to behaviors and risks are discussed, with the goal of promoting maximum function and quality of life and minimizing caregiver strain. The authors discuss the dangers of physical restraints, which are commonly suggested as a response to fall risk and behavioral symptoms without an awareness of research-based data regarding their lack of efficacy. Benefits and risks of a variety of need-based interventions are presented in a practical, clinically relevant manner. The discussion of diverse safety-enhancing interventions is intended to enable clinicians and caregivers to identify individualized care strategies for patients with frontotemporal dementia.

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