Study highlights lack of BPSD clinical pathway

A University of South Australia study has identified a gap in clinical pathways for managing behavioural and psychological symptoms of dementia in residential aged care.

The residential aged care sector lacks a clinical pathway for managing dementia-related behaviours, according to University of South Australia research.

The literature review, published in the Australasian Journal on Ageing, aimed to identify a clinical pathway or practice guidelines to inform a clinical pathway for managing behavioural and psychological symptoms of dementia (BPSD) in residential aged care facilities.

The researchers identified 509 publications, seven of which met the inclusion criteria.

Kate Kennedy

Lead researcher Kate Kennedy said the main finding was the lack of a clinical pathway specific to the non-pharmacological management of BPSD in Australian aged care facilities.

“There was not really anything that could be used by nurses and personal care workers that didn’t involve a call to the general practitioner or geriatrician,” Ms Kennedy told Australian Ageing Agenda.

However, the review did find high-quality guidelines and recommendations on the prevention and management of BPSD, Ms Kennedy, research projects coordinator at the Rosemary Bryant AO Research Centre at the University of South Australia.

Rosemary Bryant AO Research Centre director Professor Marion Eckert, who was oversaw the project, said the findings were a cause for concern.

Professor Marion Eckert

“It comes as quite an alarming discovery because the care of people with dementia is so common in our residential aged care facilities and higher acuity facilities. And yet we had no structured clinical pathway that clinicians could follow that was evidence-based,” Professor Eckert told AAA.

Ms Kennedy said the review identified four critical phases to be included in any evidence-based clinical pathway for managing BPSD.

The phases include:

  • a risk assessment of the person’s current health and wellbeing to enable later identification of possible causes or triggers for any changes in the person’s behaviour
  • prevention for no or low risk of BPSD, such as person-centred care based on knowledge of the person
  • watchful waiting for mild to moderate risk of BPSD, such as addressing unmet needs and introducing individualised non-pharmacological interventions
  • escalation for high risk of BPSD, such as referral to acute or specialist services and pharmacological interventions.

“Those stages can be coordinated and managed by nurses who are supported by the other care staff within the residential aged care facilities,” Ms Kennedy said.

Clinical pathways are a good tool for nurses to justify their actions, Professor Eckert said.

“It can provide junior nurses to more senior nurses a framework to be able to deliver quality care,” said Professor Eckert.

This research is part of a larger project to develop an evidence-based best-practice clinical pathway based for use in aged care in Australia.

The results of a pilot of a clinical pathway with one residential aged care facility are being prepared for peer-review, Ms Kennedy said.

The team hopes to test the clinical pathway on a larger scale with multiple aged care facilities, she said.

Access the study.

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Tags: behavioural and psychological symptoms of dementia, bpsd, clinical pathway, dementia, kate kennedy, professor marion eckert, university of south australia,

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