Abstract
Background/Objective: People living with dementia (PLWD) in residential aged care homes (RACHs) are frequently prescribed psychotropic medications due to the high prevalence of neuropsychiatric symptoms, also known as behaviours and psychological symptoms of dementia (BPSD). However, the gold standard to support BPSD is using psychosocial/non-pharmacological therapies. This study aims to describe and evaluate services and neuropsychiatric outcomes associated with the provision of psychosocial person-centred care interventions delivered by national multidisciplinary dementia-specific behaviour support programs.Methods: A 2-year retrospective pre-post study with a single-arm analysis was conducted on BPSD referrals received from Australian RACHs to the two Dementia Support Australia (DSA) programs, the Dementia Behaviour Management Advisory Service (DBMAS) and the Severe Behaviour Response Teams (SBRT). Neuropsychiatric outcomes were measured using the Neuropsychiatric Inventory (NPI) total scores and total distress scores. The questionnaire version “NPI-Q” was administered for DBMAS referrals whereas the nursing home version “NPI-NH” was administered for SBRT referrals. Linear mixed effects models were used for analysis, with time, baseline score, age, sex, and case length as predictors. Clinical significance was measured using Cohen's effect size (d; ≥0.3), the mean change score (MCS; 3 points for the NPI-Q and 4 points for the NPI-NH) and the mean percent change (MPC; ≥30%) in NPI parameters.Results: A total of 5,914 referrals (55.9% female, age 82.3 ± 8.6 y) from 1,996 RACHs were eligible for analysis. The most common types of dementia were Alzheimer's disease (37.4%) and vascular dementia (11.7%). The average case length in DSA programs was 57.2 ± 26.3 days. The NPI scores were significantly reduced as a result of DSA programs, independent of covariates. There were significant reductions in total NPI scores as a result of the DBMAS (61.4%) and SBRT (74.3%) programs. For NPI distress scores, there were 66.5% and 69.1% reductions from baseline for the DBMAS and SBRT programs, respectively. All metrics (d, MCS, MPC) were above the threshold set for determining a clinically significant effect.Conclusions: Multimodal psychosocial interventions delivered by DSA programs are clinically effective as demonstrated by positive referral outcomes, such as improved BPSD and related caregiver distress.
Highlights
Dementia is a global health priority with significant socioeconomic costs [1]
This study aims to [1] describe and compare the structure and characteristics of Dementia Support Australia (DSA) programs, and [2] evaluate the impact of these programs on referrals with behaviours and psychological symptoms of dementia (BPSD) from residential aged care homes (RACHs) in terms of improvement in neuropsychiatric or BPSD outcomes for the people supported by the services, and the distress caused to their caregivers
For the Dementia Behaviour Management Advisory Service (DBMAS) program, the total Neuropsychiatric Inventory (NPI) score is calculated as the sum of the 12 domain severity scores, and for the Severe Behaviour Response Teams (SBRT) program the total score is calculated as the sum of the frequency multiplied by severity scores for each domain (0–144)
Summary
Dementia is a global health priority with significant socioeconomic costs [1]. Regardless of dementia subtype, behaviours and psychological symptoms of dementia (BPSD) are common and difficult to support, affecting up to 90% of individuals with the condition [2]. Due to escalated and complex care needs, BPSD are one of the primary reasons for residential aged care placement [3]. Up to 91% of people living with dementia (PLWD) in Australia will live their final years in supported residential accommodation [4]. In Australia, there are over 200,000 people living in residential aged care homes (RACHs) [5], where cognitive impairment or dementia affects at least 52% of residents and up to 90% of those are residing in high-level care [6]. High quality care involves a person-centred approach, which requires a thorough understanding of the care needs of residents, including those with BPSD. It has been estimated that 10–15% of aged care beds are required to meet the needs of residents exhibiting moderate-to-severe BPSD [7]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
