Person-Centered Behavioral Approaches to the Management of BPSD

by Timothy Gieseke MD, CMD

In JAMDA, the Journal of Post-Acute and Long-Term Care (formerly the Journal of the American Medical Directors Association), I recently read an interesting article with Dr. Barbara Resnick as the lead investigator on the value of a checklist for auditing facility care plans for persons with dementia.  To quote this article, “Behavioral and Psychiatric Symptoms of Dementia (BPSD) occur in about 90% of persons with dementia over the course of their dementia. Close to 20% of residents  with dementia living in long-term care facilities have behaviors that interfere with daily living. BPSD contributes to poor quality of life, more rapid cognitive and functional decline, and puts residents at risk for inappropriate use of antipsychotics as well as other psychotropic medications (antidepressants, anxiolytics, and sedative/hypnotics). The use of psychotropic medications among individuals with dementia has been associated with more rapid physical and cognitive decline than would otherwise be anticipated and use of these drugs has led to little or no improvement in BPSD.”

In this study, a nice list of “Person-Centered Behavioral Approaches to the Management of BPSD” was provided (see link), which I believe would be a valuable resource for a facilities Behavioral Assessment and Management Team.  To test the effectiveness of a facility’s implementation of a Person-Centered Approach for BPSD, an audit tool was developed and tested (see link) in 14 SNFs for 137 patients. The tool focused on 8 problem behaviors that typically don’t respond to medications (Apathy, Agitation, Inappropriate and disruptive vocalizations, Aggression, Wandering, Repetitive behaviors, Resistance to care, and Sexually inappropriate behaviors).

Their audit checklist tool found more than half of the care plans (78) had insufficient use of appropriate behavioral interventions.  Care Plans with higher adaption scores documented patients who experienced improved quality of life, reduced evidence of depression (Cornell Scale for Depression in Dementia – CSDD), and reduced agitation (Cohen-Mansfield Agitation Inventory – CMAI).  Restiveness to care was not affected.

At CALTCM and on the California State Partnership for Improving Dementia Care, we support interventions for BPSD that are safe, person-centered, and improve the quality of life of persons with dementia. In the past, we have over-relied on medications for BPSD, but the literature no longer supports that approach.

I believe this study gives facilities more guidance on how to improve their dementia care.  I hope to see facilities submit Best Practices and Posters in this evolving area of medicine at our annual CALTCM meeting next April.

Click here for JAMDA article:

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