A nest is a carefully crafted place that provides structure, safety, warmth, and caring. This guide was created with these qualities in mind. Healthcare providers serving as behavior specialists for older adults with dementia should be encouraged to examine the Needs, Environment, Stimulation, and Techniques (N.E.S.T.) used in the care of the individual with disturbing behaviors. With this newfound information the team can create an appropriate plan of care and a supportive nest for living an active, engaged life, despite memory loss.
This guide compiles the research evidence on psychosocial 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.
With this guide, we are suggesting that a nonpharmacological approach should be attempted before psychoactive medications are prescribed. Psychosocial 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. While there are many unanswered questions that need additional research, this is an exciting new initiative for dementia care providers.
Section One defines the problem and explains the various dementia types. A review of the risks for disturbing behaviors is described. Key terms are defined for reference. Section Two examines the N.E.S.T. framework, including unmet needs, the environment, stimulation and rest, and staff techniques. Section Three is a review of the current literature on nonpharmacological interventions for disturbing behaviors in older adults with dementia. Section Four explains the steps in the treatment process, and includes suggested screening and evaluation instruments. The principles of the four As and how they affect communication are also described. Section Five describes considerations for the Protocols. The first part of this section should be a review for most healthcare providers who have worked with older adults with dementia. The second half of this section describes common comorbid medical conditions that a behavior specialist may encounter in older adults with dementia. Section Six provides basic information to use in the selection of interventions. It is the one section that should be referred to time and time again for the implementation phase of the therapeutic N.E.S.T. process. A good understanding of the previous five sections will provide the behavioral therapist the best knowledge for selecting appropriate and effective interventions. Section Seven contains various forms and assessment tools, and Section Eight is the reference section.
Section One: Introduction
Section Two: Theoretical Framework to Support the N.E.S.T. Approach
Section Three: Literature Review
Section Four: The N.E.S.T. Team Process
Section Five: Considerations for Protocols
Section Six: The Protocols
Section Seven: Appendices
Section Eight: References
