What Do We Know About Behavioral Crises in Dementia? A Systematic Review

Backhouse, Tamara; Camino, Julieta; Mioshi, Eneida

doi:10.3233/jad-170679

Cited by 33 publications

(31 citation statements)

References 45 publications

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“…7,8 However, up to 50% of persons living with dementia display paranoia or hallucinations 7 and most demonstrate behavioral and psychiatric symptoms in dementia. [2][3][4] Intoxication with alcohol is common among older adults with 9% qualifying as binge drinkers and 2%…”

Section: Causes Of Agitation In Older Adultsmentioning

confidence: 99%

The agitated older adult in the emergency department: a narrative review of common causes and management strategies

et al. 2020

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Agitation and aggression are common in older emergency department (ED) patients, can impede the expedient diagnosis of potentially life‐threatening conditions, and can adversely impact ED functioning and efficiency. Agitation and aggression in older adults may be due to multiple causes, but chief among them are primary psychiatric disorders, substance use, hyperactive delirium, and symptoms of dementia. Understanding the etiology of agitation in an older adult is critical to proper management. Effective non‐pharmacologic modalities are available for the management of mild to moderate agitation and aggression in patients with dementia. Pharmacologic management is indicated for agitation related to a psychiatric condition, severe agitation where a patient is at risk to harm self or others, and to facilitate time‐sensitive diagnostic imaging, procedures, and treatment. Emergency physicians have several pharmacologic agents at their disposal, including opioid and non‐opioid analgesics, antipsychotics, benzodiazepines, ketamine, and combination agents. Emergency physicians should be familiar with geriatric‐specific dosing, contraindications, and common adverse effects of these agents. This review article discusses the common causes and non‐pharmacologic and pharmacologic management of agitation in older adults, with a specific focus on dementia, delirium, and pain.

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Section: Causes Of Agitation In Older Adultsmentioning

confidence: 99%

The agitated older adult in the emergency department: a narrative review of common causes and management strategies

et al. 2020

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“…51 A 2018 study into the factors associated with dementia-related behavioural crises found agitation and aggression to be the most commonly reported behavioural crisis, diminishing the quality of life of both people with dementia as well as their caregivers. 54…”

Section: Ad Treatments In Clinical Trialsmentioning

confidence: 99%

New approaches for the treatment of Alzheimer’s disease

Fish

Steadman

Bayle

et al. 2019

Bioorganic & Medicinal Chemistry Letters

135

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Alzheimer's disease (AD) is the most prevalent chronic neurodegenerative disease. Current approved therapies are symptomatic treatments having some effect on cognitive function. Therapies that target amyloid (A) have been the focus of efforts to develop a disease modification treatment for AD but these approaches have failed to show any clinical benefit so far. Beyond the 'A hypothesis', there are a number of newer approaches to treat AD with neuroinflammation emerging as a very active area of research based on risk gene analysis. This short review will summarize approved drug therapies, recent clinical trials and new approaches for the treatment of AD.

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“…A mental health crisis often means that the person with dementia does not feel able to cope or be in control of a situation [ 1 ]. Several factors may be associated with an episode of crisis, such as difficult behaviours (e.g., agitation/aggression, delusions, wandering, dysphoria, resistance to care) and/or physical illness or stress in the carer [ 2 ]. When the crisis is not properly managed, it can lead to increased use of emergency care services and hospital or long-term care admission [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…For example, a difficult situation may be interpreted as critical by the carer and lead to a call for professional help, without necessarily being experienced as a crisis by the person with dementia. A crisis can resolve spontaneously (e.g., the feeling of loss experienced by a person with dementia may disappear when the carer is home) or remain unresolved even after professional input (e.g., the person may become aggressive towards the carer thinking that s/he is a stranger and this episode is repeated over time with no benefits experienced from either medication or aggression/agitation management plans) [ 2 ]. In the UK, multidisciplinary teams have been established as a secondary care service to avert crises.…”

Section: Introductionmentioning

confidence: 99%

Involving the Person with Dementia in Crisis Planning: Focus Groups with Crisis Intervention Teams

Bosco

Schneider

Lorito

et al. 2020

IJERPH

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Dementia leads to progressive critical situations that can escalate to a crisis episode if not adequately managed. A crisis may also resolve spontaneously, or not resolve after receiving professional support. Because of the intensity of the crisis, the extent to which the person engages in decision making for their own care is often decreased. In UK mental health services, ‘crisis teams’ work to avert the breakdown of support arrangements and to avoid admissions to hospital or long-term care where possible. This study aimed to explore the views of crisis teams about promoting the involvement of the person with dementia in decision-making at all points in the care pathway, here defined as co-production. The staff of crisis teams from three NHS Trusts in the UK were interviewed through focus groups. Data were analysed using framework analysis. Three focus groups were run with 22 staff members. Data clustered around strategies used to promote the active involvement of the person with dementia, and the challenges experienced when delivering the care. Staff members reported that achieving a therapeutic relationship was fundamental to successful co-production. Miscommunication and/or lack of proper contact between the team and the individuals and carers receiving support adversely affected the quality of care. Making service users aware of the support provided by crisis teams before they need this may help promote a positive therapeutic relationship and effective care management.

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What Do We Know About Behavioral Crises in Dementia? A Systematic Review

Cited by 33 publications

References 45 publications

The agitated older adult in the emergency department: a narrative review of common causes and management strategies

The agitated older adult in the emergency department: a narrative review of common causes and management strategies

New approaches for the treatment of Alzheimer’s disease

Involving the Person with Dementia in Crisis Planning: Focus Groups with Crisis Intervention Teams

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