Behavioural and Psychological Symptoms of Dementia (BPSD) are defined by the International Psychogeriatric Association as 'symptoms of disturbed perception, thought content, mood, and behaviour frequently occurring in patients with dementia'.
The term BPSD is currently used in research and some medical settings. You may also see the term in some DBMAS resources. BPSD may include aggression, agitation, wandering, verbal outbursts, delusions, hallucinations, apathy and anxiety.
It is helpful to think of behavioural and psychological ‘symptoms’ in dementia as behavioural expressions with multiple contributing factors, unmet needs, change in circumstance, emotions or clinical changes.
Behavioural expressions are usually indicators or signs of distress involving:
- changes in perception and thinking;
- altered moods;
- communication problems; and
- difficulties using coping skills and resources which, in the past, helped the person to cope with life’s ‘ups and downs’.
Knowing who the person is – their unique situation and story - is a key to understanding behaviour. Good clinical care is also a priority because pain, other health issues such as infections and medication side effects, are significant contributing factors or causes.
Other contributing factors, beyond the changes in the person’s brain, can include:
- the person with dementia feeling threatened or their personal space is being violated (e.g. during personal care);
- feelings about being a recipient of care and task focussed care;
- a lack of meaningful activity or occupation, being unsure what to do or what is expected;
- a confusing, uncertain, noisy or rushed environment;
- feelings of frustration, grief, loneliness and isolation;
- strong memories from the past which can get mixed up with the present circumstances;
- fatigue and lowered stress thresholds;
- changes to sleep patterns and difficulties getting adequate sleep.
There is usually more than one contributing factor to a behavioural expression. Understanding the person, their physical and mental health and their current environment, is the best way we have of uncovering what is underlying the person’s behavioural changes.
Interventions which address these contributing factors rather than the behaviour itself, are more likely to be successful. Responses and approaches which are tailored to the uniqueness of the person living with dementia will also be more likely to alleviate distress and enhance quality of life.
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