Psychosocial interventions are more effective at reducing severe behaviours among aged care with dementia than antipsychotic drugs, a study of almost 6,000 referrals has found.

The study analysed 5,914 behavioural and psychological symptoms of dementia (BPSD) referrals from 1,996 aged care homes to the federally-funded Dementia Behaviour Management Advisory Service (DBMAS) and the Severe Behaviour Response Teams (SBRT).

Dementia Support Australia, which is led by aged care provider HammondCare, operates the DBMAS and SBRTs as part of a three-level nationwide free service to support people experiencing BPSD, which includes agitation and aggression, abnormal motor behaviour, anxiety, delusions, hallucinations, and disinhibition. 

The study, which was published in the Frontiers in Psychiatry journal this month, aimed to evaluate the outcomes of the psychosocial and person-centred care interventions delivered by DBMAS and SBRTs using the dementia behaviour measuring tool Neuropscyhiatric Inventory (NPI).

It found significant reductions in total NPI scores of between 61 and 74 per cent, which compares to an average reduction of 8 per cent when antipsychotic medications have been studied for the same purpose.

Stephen Macfarlane

Lead researcher Associate Professor Stephen Macfarlane said the research shows that non-pharmacological, or psychosocial, interventions are more effective than antipsychotic medications.

“The study is showing across a very large number of people, these tailored personalised non-pharmacological interventions produce results that are an order of magnitude greater than those that we see with antipsychotics,” Professor Macfarlane told Australian Ageing Agenda.

“Our whole philosophy of care is that a behaviour, whether it’s agitation or aggression has a cause, so we focus on identifying the cause or causes and there’s often multiple causes across multiple different behaviours that we see referred,” said Associate Professor Macfarlane, who is head of clinical services at Dementia Support Australia.

The support services then tailor the interventions specifically towards a particular cause in any given person, he said.

“It’s not a single intervention applied blindly like aromatherapy or pet therapy but it’s tailoring the intervention towards that particular person’s causes for distressed behaviour; that is what the study is showing.”

Associate Professor Macfarlane said the interventions may include aromatherapy or pet therapy plus  diversional activities or asking staff to modify how they approach a particular person.

However, he stressed it was not one-size-fits-all approach.

Psychosocial interventions are not as widely used in residential aged care as they should be, in part due to the aged care workforce and the specific pressures workers are under, Associate Professor Macfarlane said.

He said residential aged care staff are often unable to spend meaningful time with the people they care for and there is a general lack of training of staff.

“Despite there not being enough staff, the staff that we currently have don’t receive adequate training during their basic qualifications to allow them to make these assessments. You can become a personal care assistant doing a six-week online course with no mandatory module on dementia,” Associate Professor Macfarlane said.

Several recommendations from the Royal Commission into Aged Care Quality and Safety’s final report could help address these issues, such as having staffing ratios in aged care and implementing minimum mandatory training requirements including in dementia, he said.

Mike Baird

“You can’t take each of these problems in isolation, but the royal commission’s recommendations across a number of fronts will help address that lack of skill and the length of time that staff currently have to conduct these assessments and implement the interventions,” he said.

HammondCare chief executive Mike Baird said the study was a “game changer” for how BPSD should be treated in aged care.

“The evidence is in that for the overwhelming number of people living with dementia experiencing BPSD, the best approach is tailored psychosocial care strategies,” Mr Baird said.

Access the study Evaluating the Clinical Impact of National Dementia Behaviour Support Programs on Neuropsychiatric Outcomes in Australia here.

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3 Comments

  1. I thought entry qualifications for care assistants in the Community or Nursing Homes was a minimum of Certificate Level 3 or even level 4. These particular courses are delivered by TAFE or by leading service providers and do include a module on Dementia. There are also Core units and then electives, but there also needs to be workplace training which is ongoing and with workplace training in different wards to maximise staff training.

  2. Thank you for this great story. It confirms what I have believed for many, many years.
    As the Lifestyle Coordinator, I welcome the opportunity to consult with the DBMAS team whenever they are called. There were far too many occasions that the clinical team did not bother to invite me, but fortunately the DBMAS team knew that the Lifestyle staff would be instrumental in implementing the strategies developed and would make sure that I was included.
    The article suggests, correctly, the “specific pressures” and “general lack of training” as contributing factors to the lack of ability to implement psychosocial interventions appropriately. The Lifestyle team is actually well suited to support these interventions. The Lifestyle team are the perfect solution to this issue.
    We ARE trained with a focus on “Person-centred Care.” Our role is to support meaningful engagement!
    There is a catch, though. There is no requirement for residential care homes to employ Lifestyle staff. I have worked in a home where the residents enjoyed a whopping 10-12 minutes per day of Lifestyle staff time (with none on Sundays). That included the Coordinator’s time as well. Given the amount of documentation that is also necessary, you can guess who ended up with the short end of the stick.
    I will advocate loudly and often for increased hours of Lifestyle staff to become a requirement for the elders that we care for. They deserve absolutely NO LESS!!!

  3. If I am reading this right, a tailored plan is written by the Diversional / Lifestyle Co-ordinator (and in some cases assistants). The Diversional/Lifestyle plans co-exists with clinical plans and assessments, however it is more around the capabilities of that individual taking into account plans around Social / Physical / Emotional / Spiritual / Religious / Cultural / Creative / Cognitive needs. But the kicker here is – who reads them? Which home gives Care Staff/Nurses the time to read an individual’s social needs plan? I haven’t seen it in 12 years, unless the individual takes it onto their own shoulders to do so. If the Social etc needs are as important (and I am biased here at times more so than clinical), then why does the government not see this division as an Essential workforce? We are also involved in daily, weekly and monthly reports, internal assessments etc etc. We do more than deliver a Bingo activity weekly – although look up the cognitive benefits of this humble therapeutic activity. Again I say – Ratio’s – not only amongst Care Staff who are over worked and under-resourced; Nurses – who also deal with the emotions of families; but also Diversional Therapist/Lifestyle folk.

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