Transcript BPSD_2015 - Grampian Dementia Care

BPSD
Dr Alison Haddow
2015
BPSD
• Types
• Assessment
• ABCD of Management
• Case Discussion
Behavioural Symptoms
• Agitation
• Aggression
• Inappropriate vocalisation
• Culturally inappropriate behaviour
• Sexual disinhibition
• Hoarding
• Shadowing
• Etc etc
Psychological Symptoms
• Anxiety
• Depression
• Hallucinations
• Delusions
• Paranoid thinking
• Suicidal Ideation
Causes of BPSD
Physical
Delirium
Pain
Medication
Constipation
Impaired
hearing/vision
Fatique
Environment
Communication
Change in
environment
</> stimulating
No signage
Lighting - dim/glare
Restrictive area
Temperature
7%
38%
55%
Body Language
Tone of voice
Words
Treatment of BPSD
Physical
Treat
Environment
Modify
Relaxation Tx
Communication
‘Key’
Medication
Anxiolytic
Antipsychotic
Antidepressant
ABC-D of Management of BPSD
A= Activating Event
D= Debrief; Decide
B = Behaviour
C = Consequence
Preventing & Managing Aggression
A = Activating Event
To prevent aggression, follow the Top Tips. If aggression
occurs establish the activating event, or trigger.
There is always an A.
Immediate management strategies:
D=Decide & Debrief
What changes do you need to make environmental, staffing.
How can you change A to better manage
B? Brainstorm!
D = De-escalate
Allow time for recovery
Remove other people from danger
Remove potential weapons
Give the person space (stand back)
Communicate in a calm, non-
confronting way - avoid asking
'What' or 'Why' - (remember
communication is 55% body
language, 38% tone of voice & only
7% words)
Encourage the person to talk about
how they are feeling
Empathise, ie: I can see you are very
angry, frightened etc………….
Allow the person time to talk
through their issues & establish what
the problem is (try to put yourself in
their shoes)
.
Behaviour will escalate if it's not well managed.
C = Consequence
What was the consequence of B?
Assess why the person was aggressive - are they unwell, in pain?
B = Behaviour
What happened as a result of A?
Describe the actual behaviour, ie;
verbal/physical aggression; weapon
used (urinal, walking stick etc)
STOP!
Decision point!
Back off or
continue?
When to stop Antipsychotics
• Low dose
• High dose
Cochrane review: 9 trials withdrawal/cont.
Most no problems
Relapse rate higher esp. Severe BPSD