Melanie Perry has been on a Three-decade-long mission, serving those living with memory loss conditions. She has earned degrees in the field of Psychology from Indiana University, the University of St. Francis, and Nova Southeastern Universities. Melanie is currently serving as the Life Enrichment and Cognitive Wellbeing Specialist at the Home Office level for Primrose Retirement Communities and created the Silver Lace Memory Care by Primrose service program on behalf of that company.

Through this article, Perry highlights that while there has been progress in reducing the use of certain medications, there is a concerning trend of substituting them with other medications with similar harms and questionable benefits.

Ask seasoned senior living professionals how the use of psychopharmacological interventions has evolved, and many will tell you we’ve made progress. Medications such as antipsychotics and opioids are now prescribed less frequently and with greater caution. However, this prompts an important question: Have we truly adopted a holistic, well-being-focused model of care, or have we simply substituted one set of medications for another?

A 2023 study published in the Journal of the American Geriatrics Society* suggests this issue warrants closer examination. While the study highlights a decrease in the use of antipsychotic and opioid medications for managing behavioral and psychological symptoms of dementia (BPSD) and chronic pain in older adults, it also reveals a concerning trend. Medications such as gabapentin, trazodone, and valproic acid are being increasingly used for similar purposes, often off-label.

One review of the study states, “This raises an important issue, one of a recurring pattern of off-label psychotropic substitutions to treat conditions such as behavioral and psychological symptoms of dementia (BPSD) and chronic pain in older adults. It also highlights how well-intentioned deprescribing efforts may result in the unintended consequence of increasing use of medications with similar harms and questionable benefits.”
These findings call for reflection. Are we tracking not only reductions in certain medications but also the substances replacing them? Are we staying true to the commitment to holistic, well-being-focused options?

“Life enrichment professionals go beyond traditional caregiving, crafting experiences tailored to each individual’s history, preferences, and abilities. By addressing unmet needs that manifest as behavioral expressions such as frustration, boredom, or loneliness, they foster emotional well-being and a sense of purpose.”

The answer may lie in a growing trend toward non-pharmacological, wellness-based approaches. These approaches, often spearheaded by life enrichment and holistic dementia care professionals, prioritize health, engagement, and quality of life over medication. Today, life enrichment and holistically oriented professionals are as vital in preventing and managing BPSDs as clinical providers were in the past.

Life enrichment professionals go beyond traditional caregiving, crafting experiences tailored to each individual’s history, preferences, and abilities. By addressing unmet needs that manifest as behavioral expressions such as frustration, boredom, or loneliness, they foster emotional well-being and a sense of purpose.

Integrating these strategies into care plans can dramatically reduce reliance on psychotropic medications. This shift not only improves residents’ quality of life but also reaffirms the profession’s commitment to a well-being-focused care model that honors the dignity and humanity of individuals living with dementia.

Moving forward, senior living communities must recognize the transformative potential of life enrichment and dementia care professionals. Their work is far more than a full calendar of activities—it is an essential part of addressing BPSDs and enhancing overall quality of life. True progress requires consistent collaboration between life enrichment professionals and clinical teams, focusing on resident-driven care outside of routine meetings.

Finally, equipping these professionals with the resources, training, and tools necessary to create meaningful, data-driven wellness plans is crucial. By supporting their efforts, we can move closer to the ultimate goal: reducing reliance on side-effect-heavy psychotropics and achieving truly holistic, person-centered care.