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Psychology and Mental Health

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Best practice in training and implementing evidence-based care for behaviors

Author(s): Buettner LL, Fitzsimmons S



Nearly 2 million people in the United States are in the mid to late stages of a dementia related illness such as Alzheimer's disease. They may not recognize family members, depend on others for help with daily activities, may be lethargic and unable to communicate their needs, and have distressing numbers of behavioral problems that lead to the prescription of powerful psychoactive medications. Despite the prevalent thinking that these disturbing behaviors are the result of unmet needs, a methodical system has not been designed to help recreational therapists address these problems in a consistent way. This guideline was created to provide a reliable approach to positive behavior change in dementia care settings, based on the most current research evidence. Specifically, this is an evidence-based practice guide for disturbing behaviors of dementia for the practicing geriatric recreational therapist in all care settings.


1) Use the evidence-based concept improve quality of care and services, 2) have fewer variations in practice, 3) provide cost savings that flow from appropriate intervention use, and 4) improve health outcomes in general.


This guideline compiles the research evidence on recreational therapy interventions tested on older adults with dementia to date, and directs future research by pointing out what needs to be evaluated to improve our practice. The American Therapeutic Recreation Association (ATRA) provides training sessions taught by nationally recognized experts in the field to provide recreational therapists with the advanced skills and techniques needed for making evidence-based changes in dementia care in both community-based and residential care settings across the country. Therapists who successfully complete this training are identified on a national registry maintained by ATRA.


With this guideline we are suggesting that a nonpharmacological approach should be attempted before psychoactive medications are prescribed. Recreational therapy does not have the negative side effects of powerful psychoactive medications and often changes the disturbing behaviors more quickly, thus leading to an immediate positive impact on quality of life for the older adult.

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