While lamenting the losses, limitations, and inevitable aches and pains that come with aging, many people are also quick to put a half-positive spin on it. “Well, it beats the alternative,” they’ll say. Or as nicely-aging actor George Clooney recently said, more forthrightly: “I’m kind of comfortable with getting older because it’s better than the other option, which is being dead. So I’ll take getting older.”
Now a group of researchers and practitioners specializing in aging have taken the optimistic mind/body/aging connection to a new high. Operating out of the University of Michigan in Ann Arbor, they formed the Program for Positive Aging, with the stated goal of helping “manage” the inevitability of aging to help people improve the quality of their lives as they grow older.
The program focuses on research and policy changes related to mental health and aging — especially later-life depression, anxiety, and substance abuse. The hope is to help seniors and their caregivers embrace the later years more mindfully, but also to help train the next generation of care providers and doctors to provide better care — especially for those challenged with mental illness or dementia.
To that end, the Program for Positive Aging cheerleads that it’s essential to diagnose and treat seniors suffering from depression so that they can “get back in the game” and be recognized for the contributions they can make that come steeped in wisdom and experience.
And it’s not mindless cheering. Program administrators acknowledge that nonagenarian marathon runners are the exception to the aging rule — and vow to “help older adults age well with whatever cards they have been dealt.”
Perhaps because it’s based in an academic setting, the program makes liberal use of acronyms. For example, it helps caregivers manage the BPSD of dementia with DICE. But these are acronyms loaded with meaning and well worth learning.
BPSD: A Look Within Dementia
The Program for Positive Aging starts with the recognition that caregivers can find it particularly challenging to manage the behavioral and psychological symptoms of dementia (BPSD). These are the symptoms that may seem frightening, frustrating, annoying or downright confounding — especially when they surface anew or as a departure from an individual’s usual affect, personality, or way of physical being.
The categories of BPSD include:
- Motor disturbances
- Nighttime behaviors
- Appetite and eating
- Toileting issues
Dr. Helen Kales, the program’s founder, has long been an outspoken critic of the risks of using anti-psychotic and psychiatric medication to mask these symptoms in people with dementia — a particularly prevalent practice in nursing homes.
In contrast, the Program for Positive Aging advocates that caregivers look deeper to understand the underlying causes of the symptoms, and to use other approaches, such as changes in behavior and environment, to help manage them. It’s the “person-centered” care so often advocated and espoused these days, but too seldom practiced.
Kales acknowledges that this approach to care is workier, requiring more time, patience, and effort — usually by caregivers who already feel overworked and underpaid. “Non-pharmacologic approaches will only succeed if we as a society agree to pay front-line providers for the time needed to ‘do the right thing’,” she says.
Rolling Out the DICE
Until the recognition and the money come along, the Program for Positive Aging offers free training for family and professional caregivers in the DICE Approach: Describe, Investigate, Create, Evaluate. Since it was first espoused in 2014, the DICE Approach has received wide acclaim, and has been adopted by many institutions, within the U.S. and around the world.
In applying the DICE Approach, a caregiver is asked to:
- Describe a particular behavior that seems challenging, either for the caregiver on the receiving end or the person exhibiting it — specifying the context, the social and physical environment, and the degree of stress the behavior causes
- Investigate that behavior by “playing detective” — thinking about possible underlying causes for the behavior, and ruling out possible triggers such as medication side effects, pain, sensory changes, or boredom
- Create a specific “behavior prescription” to help prevent and manage the behavior that aims to both respond to physical problems and strategize about changing behaviors such as simplifying tasks or increasing or decreasing the stimulation in the environment, and
- Evaluate whether that prescription is working after being used for a while — or whether it needs to be tweaked or changed completely.
If implementing the DICE Approach seems daunting to a caregiver, the Program for Positive Aging also offers a tool to help: WeCareAdvisor, a web-based application that can be used on a smartphone, tablet, or desktop. In about five minutes flat, it walks users through the two initial steps of DICE — urging them to describe and investigate the behavior about which they’re concerned. Based on the answers received, the app uses an algorithm to scan through a library of more than 1,000 strategies for dealing with disruptive behavior associated with dementia and comes up with tips for dealing with it, unique to the individual — the “behavior prescription” DICE promises to deliver. The prescription can be printed or emailed, allowing the caregiver to review it or share it with others who may be interested.
The final “evaluate” component of the DICE Approach comes about a week later, when the WeCareAdvisor weighs in with the user to ask how things are going, or whether new and different tips may be needed.
A second section of the tool, the “Caregiver Survival Guide,” is a comprehensive resource that provides plain-spoken answers to questions about dementia, health issues, behaviors, and medications.
For more information, or to note your interest in future DICE Approach training sessions, contact the DICE team at DiceApproach@umich.edu.