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Non-drug approaches lead to ‘massive decreases’ in BPSD


A national mobile advisory service has reduced dementia-related behaviours in aged care residents by half and helped to ease distress in staff, new data shows.

The government-established Severe Behaviour Response Teams (SBRT) service, which is operated by Dementia Support Australia, was established in 2015 to provide multidisciplinary support to aged care residents who are experiencing behavioural and psychological symptoms of dementia. 

An analysis of 173 SBRT cases for three months found severe behaviours were reduced by 50 per cent and their severity reduced by 66 per cent. There was also a 70 per cent decrease in the level of distress in aged care workers and a slight decrease in psychotropic drug use, according to the findings.

Associate Professor Stephen Macfarlane, who is head of clinical services at DSA, presented the analysis at the International Dementia Conference in Sydney today.

He said the figures provided a strong endorsement for the SBRT approach, which involved getting to know the person and their environment, rather than writing a prescription for behavioural medication.

“The findings demonstrate we can produce massive decreases in behaviour frequencies, severity and impact on residential care providers by simply using behavioural, psychological and environmental interventions,” Associate Professor Macfarlane told Australian Ageing Agenda.

An SBRT consultant provides immediate support in the event of a crisis, including visiting the facility within 48 hours, and helps aged care workers form care plans to help manage changed behaviours in people with dementia.

“These tailored personalised interventions are effective across all domains of behavioural disturbance and we are achieving these outcomes without an increase in psychotropic drugs,” Associate Professor Macfarlane said.

Solutions in care workers’ hands

In 70 per cent of cases, pain was the undiagnosed contributing factor to changed behaviours, according to the analysis.

Untreated pain is the most common factor behind changed behaviours in cases referred to both the SBRT and Dementia Behaviour Management Advisory Service (DBMAS), which DSA has been operating nationally since October 2016.

Associate Professor Macfarlane said the data being collected through both services is providing the biggest behaviour database in the world.

It includes data on the over 6,600 DBMAS cases and 660 SBRT cases in the last 12 months alone and shows strong patterns in the types of behaviours leading to referrals and the underlying causes of those behaviours, he said.

Agitation or aggression tops referral behaviours while pain followed by carer approach top the underlying causes of behaviours, according to the data.

“Given that such a high proportion of behaviours are contributed to by pain and by the impact of an incorrect or inappropriate carer approach, the solutions to those dilemmas lie in the hands of residential [care workers],” Associate Professor Macfarlane said.

Those working with residents with challenging behaviours should conduct pain checks and optimally manage pain as a first step, he said. 

The second key message is the need for all residential care workers to become familiar with the personal histories of the people that they are looking after, he said.

“If those two things alone are done by residential care that will have a significant impact on the rates of behaviour in that setting.”

DSA is funded by the Federal Government and partnered with aged care provider HammondCare.

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10 Responses to Non-drug approaches lead to ‘massive decreases’ in BPSD

  1. Jason June 8, 2018 at 12:06 pm #

    Why are you calling it behaviour related to dementia when it is clearly people mostly communicating they are in distress from untreated and unrecognised pain?

  2. Bernie McCarthy June 8, 2018 at 1:01 pm #

    How many times do we have to be surprised that non-drug approaches are effective before we begin to treat it as our first option?

  3. Sandy Phillips June 11, 2018 at 11:20 am #

    Hopefully this article will generate discussion more broadly, about this important subject as well as provide education to families and health professionals

  4. Christina Atkins June 13, 2018 at 10:57 am #

    Not all behaviours are pain related. Issues around boredom and changes in the brain contribute to increase risk of mental health issues such as depression and delusions.

  5. Philip Green June 13, 2018 at 12:57 pm #

    We operate a MENZ DEN Collective groups for mature men with dementia since September 2016 at MannaCare in Doncaster, Victoria.
    Carers have rerported noticable changes and made statements like “he comes home happier”and “he is more alert and communicative” after our discussion meetings. Interation with other men, laughter, sharing and new discussion topics help the men in coping with every day living and connection.
    We are happy to share our positive findings with other interested communities.
    For more information look at our Facebook page at MENZ DEN Collective Groups, Australia.
    Philip Green, Group Facilitator

  6. Andrew Taylor June 13, 2018 at 4:13 pm #

    How is pain being identified for these patients?

  7. K. Lavender June 13, 2018 at 5:09 pm #

    You should put the full name not just BPSD in the title or lead paragraph. It’s important to realise that your readership includes non-professionally trained people, so you must be more inclusive in your writing.

  8. Theresa June 13, 2018 at 5:34 pm #

    The PainChek app. Clinical studies conducted in Australian residential aged care centres, have been published in the Journal of Alzheimer’s Disease. The published article indicates that PainChek is a valid and reliable pain assessment tool for people with moderate to severe dementia, who can no longer self-report their pain and that it offers significant advantages over the current pain assessment methods.

  9. Debby Purse June 26, 2018 at 8:41 am #

    I agree with K. Lavender….. what does it stand for?

  10. Dr Juanita Westbury July 23, 2018 at 6:05 pm #

    behavioural and psychological symptoms of dementia – BPSD.

    This terms was coined by a large symposium of old age psychiatrists, geriatricians, allied health practitioners and other members of the IPA (International Psychogeriatric Association) about 20 years ago. Academics, such as myself tend to use this term freely without thinking about the forum.

    BPSD include mental health symptoms of anxiety, depression, psychosis and sleep disturbance as well as behavioural symptoms such as agitation, aggression, calling out, socially inappropriate behaviours, pacing, wandering, repetitive activity, delusions, apathy. There is crossover between the two types of symptoms.

    The more appropriate term now is responsive behaviours.

    I hope this helps.

    Juanita

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