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Behavioural and psychological symptoms of dementia (BPSD) are a far too common and disturbing occurrence for people with dementia, their families and those who care for them. The consequences can be not only devastating personally and challenging professionally, but also costly for service providers. In this, the fourth of this series on older people's mental health services, we describe what BPSD are, what we know about current service provision for this group and the gaps, and how commissioners might approach these issues when developing services for older people with dementia.

The purpose of this paper is to provide an overview of published literature on behavioural and psychological symptoms of dementia (BPSD) nursing in Japan and to highlight challenges that need to be resolved.

The criteria for retrieval of literature were as follows: a BPSD study conducted by a nurse in Japan, and it must have been published. Papers without conference proceedings and peer reviews and literature without English titles and abstracts were excluded. The PRISMA (preferred reporting items for systematic reviews and meta-analyses) was referenced.

Based on the analysis of 20 studies meeting the criteria, nurses tended to manage BPSD when all three of the following were clearly defined: attempts to understand BPSD, the provision of nursing intervention to improve the quality of care and clarification of the perception of BPSD. There were eight studies that implemented surveys considered to be helpful for nurses to understand BPSD with the aim of clarifying the symptomatic factors, meaning of each behaviour, etc. In the eight studies, nurses directly coped with BPSD in various ways. Four studies reported on how nurses perceive the associated behaviours and symptoms of BPSD patients.

This study suggests that not only implementing interventions but also aiming at improving nurses’ understanding of BPSD and their level of knowledge are crucial to promote BPSD nursing in Japan.

The purpose of this paper was to systematically review the association between behavioural and psychological symptoms of dementia (BPSD) and the development of carer burden. Although this association has been well established in the literature, it is not clear whether there are individual symptoms or clusters of symptoms that are particularly burdensome for carers.

A systematic review of the available literature was carried out to determine whether any specific symptom or cluster of symptoms was most closely associated with carer burden. In addition, the categorisation of behavioural symptoms, conceptualisations of burden and methods of measurement used were examined and quality of the studies appraised.

A total of 21 studies measured the association between at least one individual symptom or symptom cluster and carer burden, with all studies finding at least one symptom to be significantly associated with burden. The majority of studies were of fair to good quality. However, there was considerable heterogeneity in focus, analysis, recruitment and measurement of behaviour and burden.

Symptoms, which were found to be significantly associated with carer burden, were aggression/agitation, frontal systems behaviour, disinhibition, disrupted eating and sleeping behaviour, unusual motor behaviour, anxiety and psychotic symptoms. However, because of the heterogeneity of studies, there was insufficient evidence to establish whether any symptoms are more important than others in the development of carer burden. Future focus on clarifying the dimensions of carer burden and the mechanisms by which BPSD impact negatively on carers could inform the development of effective interventions.

One in 14 people over 65 years suffer from dementia in the UK. Over 25 per cent are receiving antipsychotics, which cause increases in mortality and cerebrovascular events. The need for a reduction and the use of alternative supportive strategies has been advocated. Risperidone at six‐week intervals is the only antipsychotic licensed for treatment with regular review. The majority of management occurs at primary care level and in care homes. The purpose of this paper is to investigate antipsychotic prescribing practices and patient review in these settings.

In total, two surveys comprising questions addressing prescribing practices were developed and distributed electronically to all GP practices and care homes in Coventry and Warwickshire, West Midlands, England.

The majority of GPs (75 per cent) reported only “occasional” discontinuation of antipsychotics due to concerns at reducing drugs on their own, expectations of regulation from secondary care and resistance from care home staff. Poor reduction levels were reported in care homes, attributing low numbers to reluctance among GPs. History of cardiovascular risk factors did not appear to influence withdrawal. Only 40 per cent of GP practices maintained sole use of risperidone. At least six‐monthly reviews were reported by 63 per cent of GPs and 64 per cent of care homes, with very few conducting reviews at least three‐monthly. The importance of non‐pharmacological alternatives was emphasized, yet access was limited and highly resource‐dependent.

This study reveals the perspectives of staff delivering healthcare for people with dementia and behavioural and psychological symptoms of dementia (BPSD). Potentially inappropriate antipsychotic principles were reported. A lack of communication and uncertainty of roles was evident. The development of understandable guidelines for healthcare workers and care home staff managing behavioural issues in patients with dementia is necessary.

Behavioural and psychological symptoms of dementia (BPSD) have been well established as factors involved in the development of carer burden. However, it is not clear which symptoms are most burdensome for carers and which caregiver factors may be involved. This study aims to explore symptoms associated with executive functioning deficits and their impact on three dimensions of carer burden and positive gain. It also aims to discover whether behaviour management strategies used by carers, and their level of experiential avoidance, had an independent impact on these factors.

A total of 110 dementia caregivers completed five self-report measures as part of a cross-sectional design: the Dysexecutive Questionnaire (DEX), Zarit Burden Interview, Positive Aspects of Caregiving Questionnaire, Dementia Management Strategies Scale and Experiential Avoidance in Caregiving Questionnaire (EACQ).

Executive functioning deficits (DEX) were found to account for most variance in burden, with DEX subscales impacting differentially on the three dimensions of burden and positive gain. The use of negative management strategies was associated with higher levels of burden, as was Active Avoidant Behaviour (a subscale of the EACQ), whereas positive management strategies were associated with positive gain.

In line with previous findings, symptoms associated with executive functioning deficits were the most significant factor in the development of carer burden. The findings relating to behaviour management strategies and experiential avoidance suggest that these could be potential mediating mechanisms in this relationship. Further research is required to explore this in detail, and to consider implications for targeted carer interventions.

Despite the longstanding use of music therapy with people with intellectual disabilities and the growing evidence base for using music therapy as a tool to aid behavioural and psychological symptoms of dementia in the general population, there is little work published which details the use of music therapy groups for people with intellectual disabilities who have a diagnosis of dementia. The purpose of this paper is to report a qualitative evaluation of staff views of a music therapy group for people with intellectual disabilities and dementia.

Carers of service users attending the group were interviewed either individually or through a focus group in order to ascertain their views about the music therapy group. The interview transcripts were then analysed using thematic analysis.

Two core themes and eight sub themes emerged from the data. These themes show that the group was felt to be pleasurable and enjoyable for the service users and that some tangible benefits of attending the group were observed by staff members. Notwithstanding the positive feedback, the results also suggested that more work is needed to inform carers of the goals and purpose of such groups. Further psycho-education for carers is suggested as a strategy to support future groups to run successfully.

There is little published research into the use of music therapy for people with intellectual disabilities who also have dementia. The current paper provides a starting point for future work in the area and further recommendations for future practice and research are considered.

The purpose of this study was to examine the literature surrounding dementia in the aging correctional population and assess the role of cognitive screening related to dementia detection within corrections. The literature regarding the role of dementia within the justice continuum is scant. Furthermore, correctional health researchers have not reached a consensus on the best age to administer cognitive screening in older persons or prioritizes a screening tool for the early detection of dementia.

A key search term list including dementia screening and was developed to review the literature surrounding dementia and the aging correctional population. PubMed, Criminal Justice Abstracts (Ebsco) and the National Criminal Justice Reference Service were used within the academic search. A gray literature search using these same search terms was conducted reviewing criminal justice federal agencies and organizations for additional information on the dementia experience within correctional settings. Snowballing was used to capture relevant theoretical and empirical knowledge.

Shortages in aging specialized health-care staffing presents a barrier for the clinical interpretation of Montreal Cognitive Assessment (MoCA) results. Correctional officers are also identified as useful candidates within the administration of cognitive screening with proper training. The MoCA may be the optimal cognitive screening tool for dementia, until an original cognitive screening tool is created specific to the correctional population. An age of 55 years or older may serve as the best cutoff score for classifying incarcerated individuals as older persons, and screening should be prioritized for these individuals. Finally, new specialized programs related to dementia within correctional settings are identified.

A limitation of this research is the conflicting opinions among researchers regarding the use of general cognitive screening tools within the correctional setting.

This research can inform correctional organizational policy and practices regarding the screening of older persons suspected of dementia. Most notably, this research proposes that correctional settings should incorporate the MoCA within initial screening of all individuals 55 years of age or older, enriching the job design of correctional officer's job positions to include cognitive testing, and for correctional settings to provide dementia and age-associated training for correctional officers. Finally, this paper informs future research in the development of a cognitive assessment tool specific to the correctional population.

About five per cent of ‐ generally very frail ‐ older people live in long‐term care in the UK; approximately a fifth of all deaths occur in care homes. Depression and dementia are prevalent mental health conditions in care homes; depression is reported in around a third of residents and dementia in two thirds. While there is some evidence about efficacy of medication in treating psychiatric and behavioural symptoms among residents, much less is known about the potential role of psychosocial interventions in enhancing mental health and quality of life. Quality of care varies widely across the carehome sector including support from primary and specialist health and quality and level of training. In terms of enhancing care quality, there is evidence that investing in staff training and conditions, establishing good links with healthcare providers, and developing care standards that genuinely promote good practice are likely to improve resident quality of life. This is an exciting area for research development and practice innovation for the future; taking account of users perspective, holds particular potential.

The purpose of this study was to develop a multi-component counseling program and examine the short-term effects of an 8-session program.

This present study was a research and development of a multi-component counseling program for enhancing resilience. The concept of resilience was reviewed based on a synthesis of existing research, together with an exploration of qualitative data derived from an interview with ten caregivers of older persons with dementia. Six domains of resilience were identified: physical, relationships, emotional, moral, cognitive and spiritual; which were then used to develop the eight-week program. The program was examined by a panel of three experts for content validity, which yielded an index of 0.87. The program was then tried out with 60 caregivers recruited and assigned 30 caregivers in the intervention and control group. The Caregiver’s Resilience Scale (CRS) was used by trained nurses to evaluate the program and data were analyzed using repeated measures ANOVA.

The results indicated that the resilience scores of the participants in the intervention group were statistically significantly higher than those of the control group at one month after program participation and at the follow-up three months later (p < 0.05).

It could be concluded that the program yielded support for the evidence-based practice of non-pharmacological intervention. The program would be suitable as a clinical practice guideline to provide help to caregivers of older persons with dementia at the outpatient setting.

Exercise has the potential to provide benefits for people living with dementia, yet the balance of evidence is uncertain. This paper aims to provide an evidence synthesis to determine whether exercise improves their health and well-being and what exercise should be recommended.

Structured search for existing literature reviews on exercise for dementia. Relevant articles were selected and critically appraised against systematic criteria. The findings from 15 high quality reviews were collated by using a best evidence synthesis approach.

The evidence is convincing for improving physical health, promising for cognitive benefits, mixed for psychological benefits and limited for behavioural outcomes. No evidence of harm was found. Overall, exercise can improve physical and mental health for people living with dementia: there is sufficient evidence to recommend multimodal exercise.

The potential beneficial outcomes are of significant importance both for people with dementia and their caregivers. In the absence of more specific findings, the current recommendation for older adults in general is pragmatically justified – some activity is better than none, more activity provides greater benefits. Adding social interaction may be important for psychological and behavioural outcomes.

To the best of the authors’ knowledge, this paper is the first to encapsulate the literature to date on exercise for dementia. Combining the findings from previous reviews enabled a novel synthesis across the range of relevant interventions and outcomes.