General practitioners' knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia: A mixed‐methods systematic review

Abstract

ObjectivesTo synthesise the existing published literature on general practitioners (GP)'s knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia (BPSD) with a view to informing future interventions.MethodsWe conducted a systematic review and synthesis of quantitative and qualitative studies that explored GPs' experiences of managing BPSD (PROSPERO protocol registration CRD42017054916). Seven electronic databases were searched from inception to October 2017. Each stage of the review process involved at least 2 authors working independently. The meta‐ethnographic approach was used to synthesise the findings of the included studies while preserving the context of the primary data. The Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to assess the confidence in our individual review findings.ResultsOf the 1638 articles identified, 76 full texts were reviewed and 11 were included. Three main concepts specific to GPs' experiences of managing BPSD emerged: unmet primary care resource needs, justification of antipsychotic prescribing, and the pivotal role of families. A “line of argument” was drawn, which described how in the context of resource limitations a therapeutic void was created. This resulted in GPs being over reliant on antipsychotics and family caregivers. These factors appeared to culminate in a reactive response to BPSD whereby behaviours and symptoms could escalate until a crisis point was reached.ConclusionThis systematic review offers new insights into GPs' perspectives on the management of BPSD and will help to inform the design and development of interventions to support GPs managing BPSD.

Care preferences of healthy, middle‐aged adults in Japan and the USA if they acquired dementia: A cross‐sectional observational study

“…Although older adults and terminally ill patients usually report preferring to die in their own homes, in regard to dementia, older adults also prioritize safety and supervision because of the impaired decision‐making capacity and behavioral changes associated with the condition . As many general practitioners are struggling to obtain the resources to address the behaviors and symptoms of dementia, middle‐aged adults might suppose that professional home care services are inadequate for people with dementia who require regular supervision . Some dementia‐care programs have been developed to help home‐care professionals address behavioral changes in dementia .…”

“…10 As many general practitioners are struggling to obtain the resources to address the behaviors and symptoms of dementia, middle-aged adults might suppose that professional home care services are inadequate for people with dementia who require regular supervision. 26 Some dementia-care programs have been developed to help home-care professionals address behavioral changes in dementia. 27 National dementia policies should make such programs available for people living with dementia in their own homes, as well as those in nursing homes.…”

“…This study protocol was approved by the ethics review board of the Tokyo Metropolitan Institute of Medical Science, Japan (No. [18][19][20][21][22][23][24][25][26][27], and was carried out in accordance with the Helsinki Declaration of 1975, as revised in 2013. Their continued participation was considered indicative of their consent to the questionnaire instructions provided on the website.…”

Impact of EMBODY Experiencing Dementia through New Media Exhibit: Engaging nursing students and the public about dementia through arts-based knowledge translation methods

“…[13] In a study conducted by Cousins, Bereznicki, Cooling and Peterson (2017), [14] it was found that nurses and family members strongly influence medical practitioners towards prescribing psychotropic medications, as nearly half of the sample felt that they required increased training of BPSD to manage symptoms using nonpharmacological methods, and thus reducing the use of psychotropic drugs. Similarly, Jennings et al (2018) [15] found that general practitioners felt a lack of knowledge of BPSD and their management using multiple treatment modalities, which likely contributes to the heavy reliance on pharmacotherapy.…”

<p>A Scoping Review and Template Analysis of Manual-Based Complex Interventions in Dementia Care</p>

“…Flexibility can be applied by providing frameworks or directions rather than step-bystep instructions or a combination of both while maintaining a contained setting or time and place for the intervention such as a session. 13 While reviews have been conducted to assess the availability and effectiveness of evidence-based training manuals and to inform the development of interventions, [14][15][16] the purpose of this scoping review is to learn from research studies which have taken on the challenge to construct manuals for complex interventions carried out by caregivers and tailored to the preferences, skills, and abilities of the person with dementia. With this review, we aim to stress the importance of availability of manuals through refereed journals in order to inform future research in dementia care and improve clinical interventions and care.…”