See the person, not the behaviours, urges a new dementia textbook designed to reshape aged care.
Released earlier today at the International Dementia Conference (IDC2022) in Sydney, the BPSD Textbook: Addressing behaviours and psychological symptoms of dementia, is a must-have for health and aged care workers involved in the care of people living with dementia. It aims to establish non-pharmacological interventions as the best practice response to behaviours rather than medication and restraint.
Up to 90 per cent of people living with dementia will experience forms of BPSD during their journey with the disease and many of them will be wrongly prescribed medications or chemically or physically restrained.
BPSD may include psychosis, agitation and aggression, depression, anxiety, apathy, impulsivity, pacing, vocalisations, appetite and eating changes, sleep disturbances, distress during personal care and wayfinding difficulties.
Associate Professor Colm Cunningham, one of the book’s authors along with Associate Professor Stephen Macfarlane and Dr Madeleine Healey, said understanding the person is the first and fundamental step in managing what is often complex and multifaceted.
“Changes in behaviour will have many catalysts and causes, be they as a consequence of the progressive nature of the many organic conditions encompassed by the term dementia, or on too many occasions, a reasonable response to unmet needs and circumstances a person with dementia will face,” Prof Cunningham said.
The 828-page book, which is also accessible to carers and laypeople, draws on international literature and research but also decades of practical experience of HammondCare providing dementia residential and in-home care, as well as national advisory support through Dementia Support Australia.
It features more than 50 individual case studies from the frontline of dementia care to illustrate BPSD situations and the care approach that works. Prof Cunningham said every individual with BPSD should have a holistic assessment examining lifestyle, biological, social, psychological, psychiatric, environmental, and other factors.
The BPSD Textbook begins with chapters discussing the primary dementias which include Alzheimer’s disease, vascular dementia, dementia with Lewy bodies, frontotemporal dementia, Parkinson’s dementia, and Huntingdon’s disease.
Elsewhere in the book, Professor Macfarlane, Head of Clinical Services for HammondCare’ s Dementia Centre, explains the medications prescribed for dementia – antipsychotics, antidepressants, benzodiazepines, anticonvulsants, cholinesterase inhibitors NMDA antagonists and opioids – and the limited circumstances where they are an effective response to BPSD.
“It is reasonable to conclude that the evidence base to support the use of any medication in BPSD is very limited,” Prof Macfarlane wrote. “For those agents where convincing evidence exists, the effect sizes are small, and significant problems with side effects limit their use.”
It is estimated that more than 70 per cent of people living with dementia in residential care are prescribed at least one psychotropic medication, while about 30 per cent are prescribed an antipsychotic.
HammondCare Chief Executive Mike Baird said HammondCare’s hope is the book will improve the quality of life for people with dementia and better support those who care for them.
“When we understand that behaviour is like a language – a way of expressing need such as pain, frustration, loneliness, fear anxiety or any number of common human experiences – then everything changes,” Mr Baird added.
The Australian Institute of Health and Welfare reports up to 472,000 Australians are living with dementia, including more than half of people in aged care homes.
By 2058, Australians living with dementia will more than double.
For a limited time, you can pre-order your copy of the BPSD Textbook at the discounted price of $119 (RRP $149). Enter discount code LAUNCH2022
Discounts are available from 30 August to 20 September 2022. Orders will dispatch within 7 days.