Towards family sensitive practices for behavioural and psychological symptoms of dementia (BPSD) at home
Manuel Gonçalves‐PereiraSteven H. ZaritAM CardosoJoaquim Alves da SilvaAna Luísa PapoilaRaimundo Mateos
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This chapter contains sections titled: Introduction Dementia Family As Caregivers Effects of Caregiving Helping Families Care through the Stages of Dementia Caregivers and Interventions for AD Conclusions Acknowledgements References
Family Caregivers
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Background People living with dementia often develop distressing behavioural and psychological symptoms (BPSD) that can affect their quality of life and the capacity of family carers and staff providing support at home. This systematic review of qualitative studies considers the views and experiences of people living with dementia and care providers about these symptoms and what helps to reduce their impact. Methods The two-stage review involved (a) An initial mapping of the literature to understand the range of BPSD, and how it is operationalised by different groups, to develop a search strategy; (b) A search of electronic databases from January 2000 to March 2015, updated in October 2016. Included studies focused on people living in their own homes. Data extraction and thematic analysis were structured to provide a narrative synthesis of the evidence. Results We retrieved 17, 871 records and included relevant qualitative papers (n = 58) targeting community-dwelling people with dementia and family carers around the management of BPSD. Five key themes were identified: (1) Helpful interventions/support for BPSD management, (2) Barriers to support services for BPSD management, (3) Challenges around recognition/diagnosis of BPSD, (4) Difficulties in responding to aggression and other BPSD, and (5) Impact of BPSD on family carers and people living with dementia. Conclusions Family carers sometimes feel that their experiences of BPSD may not be evident to professionals until a crisis point is reached. Some helpful services exist but access to support, lack of knowledge and skills, and limited information are consistently identified as barriers to their uptake. The lack of common terminology to identify and monitor the range of BPSD that people with dementia living at home may experience means that closer attention should be paid to family carer accounts. Future research should include qualitative studies to evaluate the relevance of interventions.
Thematic Analysis
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Psychological Distress
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Apathy
Disinhibition
Irritability
Depression
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Cognitive Decline
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Background: Behavioural and psychological symptoms of dementia (BPSD) and caregiver burden are twomajor issues in dementia patients. This study was conducted to estimate the association of BPSD withcaregiver burden in patients with dementia living in a south Indian community.Method: In a cross-sectional study done in Thalikkulam village, Kerala, 71 elderly of minimum 60 yearsand living with a primary caregiver for minimum one year were first selected with purposive sampling andscreened with Brief Community Screening Instrument for Dementia. Then BPSD and caregiver burden weremeasured by Neuropsychiatric Inventory Questionnaire and Zarit Burden Interview respectively.Result: Statistical analysis revealed that all patients (100%) experienced at least one BPSD and apathy(76.1%), delusion (74.6%) and agitation (70.4%) were the most common BPSD reported. Majority (93%) ofcaregivers reported caregiver burden. Strong positive correlation (p>0.05) was found between BPSD scoresand caregiver burden scores.Conclusion: The study found that BPSD and caregiver burden is common among community dwellingpatients with dementia and have significant association with various socio demographic variables. Thisstudy recommends that while identifying dementia in community, health professionals need to focus onmanagement of BPSD and caregiver burden which can influence the outcome of dementia.
Apathy
Caregiver Burden
Association (psychology)
Cross-sectional study
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Behavior management
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Dementia care in developing countries will continue to be provided by co-resident caregivers at home. Behavioral and Psychological Symptoms of Dementia (BPSD) are difficult to manage at home. Interventions leading to reduction or remission of reduction or remission of BPSD will be of immense help in the management of these patients.The nature and prevalence of BPSD in a community sample of patients with dementia was assessed by a clinician. The impact of these symptoms on the caregiver was assessed by measures of burden of care and the psychological well being of the caregiver. Another rater carried out these assessments independently.Prevalence of BPSD was very high and they were more common in patients with Alzheimer's Disease than patients with Vascular Dementia. They were rated as troubling to most caregivers. Caregiver burden was associated with adverse effects on the mental health of the carer.To be effective, dementia care services in developing countries need to focus on management of BPSD at home. Development of a low cost, effective and sustainable dementia care service should be given due importance by the policy makers in the developing world.
Caregiver Burden
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Objective To determine the association between caregiver characteristics and behavioral and psychological symptoms of dementia (BPSD) in patients with dementia (PWD) in a Taiwanese community-dwelling population.Methods This cross-sectional study was conducted using the data of 190 patients with Alzheimer's disease/dementia and 190 informal matched caregivers in Taiwan. BPSD were examined using the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Correlation and regression analyses were used to explore associations between caregiver characteristics and the presence, severity, and distress of NPI-Q items.Results Only spouse primary caregiver was positively associated with presence of delusions in PWD. Caregiver education was positively correlated to severity of hallucinations, agitation/aggression, and apathy/indifference in PWD, while child primary caregiver was positively related to severity of disinhibition in PWD but negatively related to severity of anxiety in PWD. Spouse primary caregiver was positively related to severity of anxiety and appetite/eating in PWD while sole primary caregiver was positively related to severity of anxiety and nighttime behaviors in PWD. Caregiver education was positively correlated to distress of agitation/aggression in caregivers while child primary caregiver was positively related to distress of disinhibition in caregivers. Spouse primary caregiver was positively related to distress of anxiety and appetite/eating in caregivers while spouse caregiver was positively related to distress of nighttime behaviors in caregivers.Conclusions Caregiver education, child and spouse primary caregiver were relevant to severity of PWD and distress of caregivers of BPSD. It is suggested that healthcare professionals provide caregivers with proper individualized interventions based on these results to enhance caring quality.Key pointsCaregiver education was positively correlated to severity of hallucinations, agitation/aggression, and apathy/indifference, and distress of agitation/aggression.Child primary caregiver was positively related to severity and distress of disinhibition but negatively related to severity of anxiety.Spouse primary caregiver was positively related to severity and distress of anxiety and appetite/eating, and distress of nighttime behaviors
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Disinhibition
Caregiver Burden
Apathy
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