UK clinicians’ views on the use of formulations for the management of BPSD: a multidisciplinary survey

Abstract

Background and Objectives:The process of formulating in the area of dementia care is at an early stage of development. A review published in 2016, identified 14 different types of formulation-based approaches for the management of Behavioural and Psychological Symptoms of Dementia (BPSD). The present study examines professionals' views about the use of systematic formulations for choosing first-line non-pharmacological interventions for BPSD.Methods: A 34-item online survey, with six items about formulation-based interventions for the management of BPSD, was circulated to multi-disciplinary UK dementia networks.Quantitative data were examined for the use of formulation-based frameworks in practice.Thematic analyses provided insight into the practicalities of using formulations. Results:The majority of the 355 participants responding to the questions stated they used formulation-led models to inform interventions, but 24% stated they did not. Thirty-two types of formulation frameworks were named, and there was a diverse spread across the UK. The Newcastle model was the most frequently used framework, with fifty percent of the participants who formulated reporting using this framework. Four themes regarding the use of formulation emerged, relating to function, process, reported outcomes and obstacles. Conclusion: Formulation-based approaches to targeting intervention are becoming popular in dementia care in the UK. More types of formulation frameworks are used in practice compared with the 2016 review. The use of formulations are seen as key to offering an alternative to pharmacological treatments. Understanding both the value of formulation-led approaches and the obstacles to their use are important to implementing NICE 2018 recommendations.

Using the Newcastle Model to Understand and Manage Behaviors That Challenge in Dementia: A Case Study

“…There are some important implications from the present case. The Newcastle model is the most common approach in managing BC in dementia in the UK (James et al, 2020). The present case report indicates that the Newcastle model has utility in managing verbal aggression and sexual comments in the context of dementia within a care home setting.…”

“…The Newcastle model is the most widely-used formulation for BC in dementia amongst clinicians in the UK (James et al, 2020). Other formulation-led approaches exist, which are similar in their non-pharmacological and person-specific emphasis (e.g., Kales et al, 2014;Karlin et al, 2014).…”

Professional perspectives on applying the NICE and British Psychological Society Guidelines for the management of Behaviours that Challenge in dementia care: an e‐survey

“…Three hundred and seventy‐eight (378) people participated in the survey. Over a third (38.6%) were nurses, with psychologists being the next most frequent contributors (22.2%), followed by psychiatrists and OTs (see James, Mahesh, Duffy, Mahesh, Duffy, Reichelt, & Moniz‐Cook, 2020 , for a full account of participants). Two hundred and forty‐seven (65.3%) participants provided quantitative data on the NICE guidance, with 158 (41.8%) giving a qualitative response (Table 1 ).…”

“…The data on guidelines discussed in this article were taken from a larger survey on aspects of BtC (James et al., 2020 ; Wolverson et al., 2019 ). Quantitative data on the use of the NICE ( 2018 ) and BPS (Brechin et al., 2013 ) guidelines with respect to clinical practice were examined, and thematic analyses from related free‐text questions provided insight into the practice implications of guidance.…”

“…Individual formulation‐led interventions for BtC (Holle, Halek, Holle, & Pinkert, 2016 ) are an important method of delivering first‐line non‐pharmacological support and published frameworks exist (see DICE, Kales, Gitlin, & Lyketsos, 2015 ). However, a related paper from the present programme of work noted that currently clinicians use in excess of thirty ‘named’ formulation frameworks for the treatment of BtC (James et al., 2020 ); hence, it is important to develop an evidence base for the frameworks and conceptual models we employ. Develop UK bespoke specific advice for practitioners and services, including case examples and clinical pathways, for delivery of non‐pharmacological interventions for BtC.…”