Nursing home physicians knowledge of and attitudes toward nonpharmacological interventions for treatment of behavioral disturbances associated with dementia

Objectives: To describe the perceptions of physicians who care for nursing home residents regarding the etiology of behavior problems associated with dementia, their attitudes toward treatment, their knowledge of nonpharmacological interventions, and relationships among these issues and demographic variables and actual practice. Design: This is a descriptive study presenting responses to a Web-based questionnaire. Participants: Participants were 110 physicians providing services in a nursing home setting. Measurements: Likert-type ratings of statements related to the etiology of behavior problems, attitudes toward treatment, and knowledge of various nonpharmacological interventions. Results: These physicians rated medical/mental health issues and system/environment/staff/care problems to be as frequently involved as dementia in the etiology of behavior problems. Their attitudes concerning nonpharmacological treatment were more positive than those for the use of psychotropic medication. There was a broad range in knowledge of nonpharmacological interventions among the respondents. They were most likely to report previous use of physical interventions and were least likely to have used sensory interventions. Physicians with knowledge of a greater number of nonpharmacological methods were more likely to use these in actual practice. Staff requests for medication and insufficient resources were reported to be barriers to the use of nonpharmacological methods. Conclusion: The frequency with which behavior problems in dementia are attributed to environmental and psychosocial causes suggests there are a large number of cases in which nonpharmacological interventions could be employed. Physicians are generally in favor of the use of these methods, but their knowledge varies. Increasing physicians' knowledge of nonpharmacological techniques would increase the likelihood of their use.