The Broken Lens of BPSD: Why We Need to Rethink the Way We Label the Behavior of People Who Live With Alzheimer Disease

Abstract

For the past 20 years, the behaviors of people who live with dementia (PLWD) that others find challenging or problematic have primarily been ascribed to Alzheimer disease and related dementias and have been assessed through the biomedical lens of Behavioral and Psychological Symptoms of Dementia (BPSD). This has led to the root causes of these behaviors being overlooked, which in turn leaves them unaddressed. Further, using the artificial construct of BPSD has led to many PLWD being inappropriately prescribed (off-label) medications that are largely ineffective in resolving the behaviors because they do nothing to remedy the underlying psychosocial and environmental causes. The fact that many of the behaviors we call BPSD are normal human responses to particular sets of circumstances can be relatively easily demonstrated by directly observing the individual behaviors of PWLD, and putting them in context, as well as by asking ourselves how we would respond under similar conditions. Re-evaluating the use of the construct of BPSD, and replacing it with a person-centered rather than disease-focused approach will result in better care as well as healthier and happier long-term care residents and staff.