A controlled trial of a predominantly psychosocial approach to BPSD: treating causality

Bird, Mike; Jones, Robert H.; Korten, A. E.; Smithers, Heather

doi:10.1017/s1041610206004790

Cited by 62 publications

(67 citation statements)

References 26 publications

(29 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…relationships and loneliness) [26,27]. Furthermore, integrative psychotherapeutic programmes in nursing homes have never been evaluated in a large-scale, comprehensive, randomised controlled study [11,17,28,29,30,31]. To address these issues, we developed a unique integrative psychotherapeutic nursing home programme, designated integrative reactivation and rehabilitation (IRR) [32].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors for a Favourable Long-Term Outcome from an Integrative Psychotherapeutic Nursing Home Programme

Bakker

Duivenvoorden

Lee

et al. 2011

Dement Geriatr Cogn Disord

View full text Add to dashboard Cite

Background/Aims: The prevalence of multiple psychiatric symptoms (MPS) in psychogeriatric patients is about 80%. MPS have negative effects on caregivers; 70–80% of caregivers are moderately to heavily burdened. We tested an integrative psychotherapeutic programme (IRR) focused on MPS as well as caregiver burden. To develop decision rules in indicating IRR, prognostic potentialities of diagnostic and functional baseline variables for a favourable outcome of IRR were identified. Methods: Patients with a DSM-IV classification of dementia, amnestic disorders or other cognitive disorders were followed in a randomised controlled trial, comparing IRR (n = 81) with usual nursing home care (n = 87). Assessments at T1 (intake) and T2 (6 months’ follow-up). Results: In the combined prognostic models Alzheimer dementia showed significant prognostic qualities for improvement on NPI sum severity (OR 3.01), IRR on general burden and competence of caregiver (OR 2.29 and 3.34). Cognitive functions had low prognostic value. Conclusion: Prognostic modelling of positive change on severity of MPS and caregiver burden was feasible. Applying three decision rules, all resulted in IRR as indicated intervention. It seems justified to refer psychogeriatric patients suffering from a broad range of cognitive function disorders, specifically patients with dementia of the Alzheimer type, to the IRR programme.

show abstract

Section: Introductionmentioning

confidence: 99%

Prognostic Factors for a Favourable Long-Term Outcome from an Integrative Psychotherapeutic Nursing Home Programme

Bakker

Duivenvoorden

Lee

et al. 2011

Dement Geriatr Cogn Disord

View full text Add to dashboard Cite

show abstract

“…8 It can be a manifestation of distress or suffering, or a reaction to distress in the carer, which may in turn increase the behavioural problems. 9 Before any treatment can be formulated, the challenging behaviour needs to be understood, and for this, a person-centred approach is essential. 10 This means that the behaviour needs to be understood on the basis of the function it serves for that individual and the reasons behind it.…”

Section: Size Of the Problemmentioning

confidence: 99%

Managing challenging behaviour in older adults with dementia

Krishnamoorthy¹,

Anderson²

2011

Prog Neurol Psychiatry

View full text Add to dashboard Cite

Progress in Neurology and Psychiatry 20C hallenging behaviour is a term that has been adapted from the field of learning disability, 1 and incorporates other terms used previously such as behavioural disturbance, problematic behaviours, behavioural problems and difficult behaviour. The concept takes into account the intrinsic and extrinsic factors involved in the aetiology. 2 Challenging behaviour puts a strain on caregivers and reduces quality of life of ser vice users and staff, leading to transfer between care setting, institutionalisation, referral to psychiatric services and admission to hospital. 3 Challenging behaviour can occur with any mental health problem but is most common and demanding in dementia. The term behavioural and psychological symptoms of dementia (BPSD) is linked to challenging behaviour, as these symptoms often result in challenging behaviour. For the purpose of this article, challenging behaviour and BPSD are used interchangeably and the focus is on dementia, although most of the principles apply generally. Size of the problemThe prevalence of BPSD varies depending on the situation, eg community, care home or hospital, how the symptoms are measured and the severity of dementia. Dementia is a syndrome caused by number of illnesses in which there is a progressive decline in cognitive function and the ability to carry out activities of daily living. There are about 700 000 people with dementia in the UK. BPSD is a strong predictor of carer distress, 4 entry into social care, 5 and is associated with impaired functional ability, poorer prognosis and caregiver burden. It also makes discharge from hospital more difficult. 6 BPSD affects up to 95 per cent of people with dementia at some point. 7 BPSD fall into three main groups: agitation, psychosis and mood disorder. 5 They increase in frequency and severity as the dementia progresses and become evident in the moderately severe stage of dementia when people are beginning to lose an awareness of their disability. Symptoms include delusions, hallucinations, anxiety, depression, apathy, agitation, misidentification and disinhibition, possibly together with behaviours such as calling out/shouting, repetitive questioning, inappropriate incontinence, sexually inappropriate behaviour, wandering and aggression. 7,8 Understanding challenging behaviour Challenging behaviour has been defined as an active attempt by the person to express an unmet need, which could be physiological or psychological. 8 It can be a manifestation of distress or suffering, or a reaction to distress in the carer, which may in turn increase the behavioural problems. 9 Before any treatment can be formulated, the challenging behaviour needs to be understood, and for this, a person-centred approach is essential. 10 This means that the behaviour needs to be understood on the basis of the function it serves for that individual and the reasons behind it. Rather than see challenging behaviour as a problem it should be seen as a method of communication: what is the person trying to tel...

show abstract

“…Indeed, as Dr Krishnamoorthy and Dr Anderson point out, there is evidence that staff training programmes, in particular those that encourage staff to identify and target the cause of the behaviour, can improve outcomes in BPSD. 7 Also invaluable is support from specialist mental health services, 4 but there are often delays in their access. The RCPsych report highlighted that while 90 per cent of hospitals provided access to liaison psychiatry services, 36 per cent of those referred had still not been seen after four days.…”

Section: Training and Supportmentioning

confidence: 99%

Untitled

2011

Prog Neurol Psychiatry

View full text Add to dashboard Cite

A controlled trial of a predominantly psychosocial approach to BPSD: treating causality

Abstract: The causality-focused approach appears to be as effective as the more common predominantly pharmacological approach, and appears to involve lower human and financial costs.

Cited by 62 publications

References 26 publications

Prognostic Factors for a Favourable Long-Term Outcome from an Integrative Psychotherapeutic Nursing Home Programme

Prognostic Factors for a Favourable Long-Term Outcome from an Integrative Psychotherapeutic Nursing Home Programme

Managing challenging behaviour in older adults with dementia

Untitled

Contact Info

Product

Resources

About