Managing Behaviours that Challenge? Promoting psychosocial interventions as a first line intervention in dementia care

Many older persons with dementia live in residential care settings and have complex needs (1). Cognitive and functional impairment often co-exist with additional mental health problems such as aggression, agitation, depression... [ view full abstract ]

Many older persons with dementia live in residential care settings and have complex needs (1). Cognitive and functional impairment often co-exist with additional mental health problems such as aggression, agitation, depression and psychosis (2). Psychotropic medications are used to control the behavioural and psychological symptoms of dementia and whilst there is evidence to suggest some moderate effectiveness, this may be offset by severe adverse effects such as sedation, falls, extrapyradimal and anti-cholinergic symptoms. Antipsychotics may increase the risk of stroke whilst benzodiazepines and antidepressants may increase the risk of falls and fractures (3). There is growing evidence that suggests staff training, promoting person centered care and utilizing non-pharmacological, psychosocial interventions improve some key health outcomes and can reduce antipsychotic drug use (4).

Aims and objectives.

To identify those persons referred to the Psychiatry Of Old-Age (POA) over one year, who currently reside in a residential care setting that presented with behaviours that challenge. To further identify the prevalence of psychotropic drug prescription as well as seeking evidence of psychosocial interventions as a management approach for these behaviours.

Methodology.

Case notes for all referrals to POA service in one calendar year were analyzed and clients in long term care homes were identified. Psychotropic medication prescription was noted. A subsequent review of available case notes (58%) sought evidence of psychosocial interventions as a management approach in addressing BPSD.

Results.

53% prescribed permanent antipsychotics, 25% prescribed permanent benzodiazepine and 66% prescribed antidepressants.
Psychosocial interventions were recommended within 72% of those case notes that were available for subsequent review; however it is unclear from the notes if these approaches were used.

Conclusion.

Pharmacological intervention is the most common approach to managing behaviours that challenge despite several studies highlighting reduced agitation for persons with dementia following interventions based on meaningful activities and psychosocial interactions (5).