Survey of aged psychiatry services’ support of older Australians with very severe, persistent behavioural symptoms of dementia

Abstract

There is no nationally accepted pathway of care for this vulnerable group or understanding of what constitutes an adequate statewide mental health service.

Specialist residential dementia care for people with severe and persistent behaviours: A ten‐year retrospective review

“…3,4 BPSD includes a heterogeneous range of symptoms including disturbance of affect, perception and thought, with clinical presentations of delusions, hallucinations and other 'behaviours of excess' such as anxiety, agitation, aggression or disinhibition, and 'behaviours of omission', including apathy and depression. 3,5 While BPSD is ubiquitous, it is estimated that less than 10% of Australians living with dementia will manifest aggression considered unmanageable in mainstream care services, and only approximately 1% will manifest very severe BPSD. 6 Severity of behaviour is a relative concept and may be applied to any behaviour that is perceived as creating difficulty for self, carers or others.…”

“…7 However, when defining severe BPSD, clinical consensus focusses on the impact of behaviours, particularly those involving physical and/or verbal aggression that threaten the safety of the person with dementia, others in their environment or property, and frequency and duration of the behaviours. 5,6,8 Severe BPSD is also associated with tenuous accommodation arrangements, more frequent transfer to acute care 8 and inappropriate or prolonged use of psychotropic medication. 5,9 For others who experience severe BPSD, there can be significant distress, poor quality of life for family, work stress for staff and increased overall costs of care.…”

“…5,6,8 Severe BPSD is also associated with tenuous accommodation arrangements, more frequent transfer to acute care 8 and inappropriate or prolonged use of psychotropic medication. 5,9 For others who experience severe BPSD, there can be significant distress, poor quality of life for family, work stress for staff and increased overall costs of care. 8 In response to calls that mainstream aged care is unable to provide appropriate and safe care for this group, in 2016 Very severe behavioural and psychological symptoms of dementia (BPSD) have low prevalence but disproportionately poor outcomes for persons with dementia, others and systems of care, including inappropriate use of medication, tenuous accommodation, poor quality of life and increased costs.…”

“…Behaviours and psychological symptoms of dementia (BPSD) occur in up to 90% of PLWD, with greater frequency as the disease progresses 3,4 . BPSD includes a heterogeneous range of symptoms including disturbance of affect, perception and thought, with clinical presentations of delusions, hallucinations and other ‘behaviours of excess’ such as anxiety, agitation, aggression or disinhibition, and ‘behaviours of omission’, including apathy and depression 3,5 …”

Patterns of Service Provision in Older People’s Mental Health Care in Australia

“…Improving healthcare and social services for older people is a priority in Australia [ 12 ], although older people’s mental health has not been included as a specific strategic goal. Psychiatric services for dementia are unevenly distributed across Australia, with the information aggregated at a state level, focussed on public health services [ 13 ], and lacking a whole system perspective [ 14 ].…”