The DICE Approach™

What is the DICE Approach?

The DICE Approach is a process that aims to help caregivers manage the behavioral and psychological symptoms of dementia (BPSD). Many caregivers experience difficulties managing BPSD which can include aggression, wandering, and refusing needed care. The DICE Approach guides caregivers through a process to give context to and identify the possible causes of BPSD. With this better understanding of why behaviors are occurring, the DICE Approach assists caregivers to target the underlying causes of the behaviors and use evidence-based behavioral and environmental strategies to create a custom plan for managing BPSD.

Heart with hands graphicThe DICE Approach Training Program

  • The PPA has done numerous DICE training programs for medical professionals, social workers and other groups as part of grant-funded programs. As we have had many requests from caregiving institutions, universities and hospitals we are working with our professionals here to begin to offer licensed on-site programs or host interested parties here. If there is interest in this, we are happy to discuss your needs and costs to meet those needs further.
  • Additionally, we recognize that there are many in-home caregivers and institutions for which The DICE Approach™ would be helpful. We are currently developing a subscription-based online training program/website for The DICE Approach™ and it will be open to the public in a few months. In conjunction with the website, we are going to republish (as part of the subscription) The DICE Approach™ manual, currently a 136-page guide to the methodology. As things get closer to release there, we will begin to announce on our website and Facebook page.



Creating the DICE Approach


Detailed DICE ApproachDr. Kales and the Program for Positive Aging have led the psychiatric field in understanding the risks of using antipsychotic and other psychiatric medication in people with dementia. As a result, Dr. Kales recognized it was not enough to simply tell providers, staff and family caregivers to avoid the use of these medications. Instead, it is imperative to help caregivers better understand, identify and treat the underlying causes of BPSD rather than resorting to the knee-jerk use of medication.

To address this need, in collaboration with Constantine Lyketsos, MD and Laura Gitlin, PhD, from Johns Hopkins University, Dr. Kales organized an interdisciplinary expert panel. The panel included members with expertise in geriatric medicine, geriatric psychiatry, geriatric psychology, nursing, social work, pharmacy and behavioral science. This group created an algorithmic approach toward assessment and management of BPSD called DICE (Describe, Investigate, Create, Evaluate). The DICE Approach is an adaptation of the clinical reasoning process used by geriatric psychiatrists to assess and manage BPSD.

Since its publication in 2014, the DICE Approach has received national and international adoption and acclaim including. San Diego county adopted DICE as its evidence based approach and it has been put to use in Canadian nursing homes and UK care homes.


Stay in touch! For questions or interest in future DICE Approach trainings, reach out to the DICE Team at