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Understanding environment critical to BPSD management: expert

The tendency to look for quick-fix solutions has fuelled the overuse of antipsychotics in dementia care but a shift away from pharmacological interventions in aged care is growing, according to experts.

Hazel Bucher, a nurse practitioner in aged care and research associate with the University of Tasmania, said there was significant cultural change underway within the industry to identify the environmental and situational triggers that could exacerbate behaviours.

Historically the response from health professionals and carers had been to try to ‘fix’ a person’s behaviour rather than to understand the context in which they appeared, Ms Bucher said.

“It’s up to us to try to understand why these behaviours are happening,” she told an Australian Association of Gerontology webinar on the behavioural and psychological symptoms of dementia (BPSD) on Tuesday.

“We are part of the problem – we are asking a person with limited cognition to function in an environment that’s overwhelming for them.”

While the judicious use of antipsychotic medication could make an important difference to a resident with dementia, Ms Bucher said that pharmacological interventions were part of a bigger puzzle in the dementia response and management.

While behavioural and psychological symptoms were common, they were not a normal part of the experience of dementia, she said.

Neuropsychiatrist Dr Patrick O’Brien, from St Vincent’s Hospital in Melbourne, said medication and non-pharmacological interventions needed to work together and that finding enjoyable roles and routines for people with BPSD were vital.

To emphasise the importance of maintaining roles and thinking creatively in dementia care,  Ms Bucher, who is also part of the Dementia Behaviour Management Advisory Service (DBMAS) in southern Tasmania, told the story of a male resident whose agitated behaviour resulted in him walking the facility’s corridors with equipment such as wheelchairs, hoists and walking frames in hand.

The resident, who had been recently admitted to the facility, became verbally aggressive if anybody stood in his way or attempted to stop him.

However, discovering that the resident used to be a long-distance runner, a carer decided to involve him in pushing the linen trolley around the facility, while engaging in conversation with staff.

By understanding his story and creating a purpose and routine for him in the facility his agitated behaviour eased, said Ms Bucher.

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