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Managing Behavioral and Psychological Symptoms of Dementia (BPSD)

Dementia poses a significant challenge, often manifesting as behavioral and psychological symptoms dementia that can be distressing for both the patient and their caregivers. However, a range of effective strategies can be employed to address these issues and ensure a better quality of life for those affected.


Aggressive behavior

Behavioral and Psychological Symptoms of Dementia (BPSD)


Exploring Non-Pharmacological Strategies

When dealing with BPSD, non-pharmacological strategies are the initial line of action. These tactics focus on identifying and addressing both internal and external stressors that contribute to the symptoms. Careful consideration of the patient's needs and environment can make a significant difference.

Engaging Family and Carers

In developing a comprehensive care plan, the involvement of family members and caregivers is crucial. By including them in the process, their insights and support can contribute to more effective outcomes.


Tailoring Person-Centered Intervention Plans

Crafting a person-centered intervention plan is paramount when managing BPSD. Here are some effective strategies to consider when these symptoms arise:

Reassurance and Trigger Reduction

  • Actively listen to the patient, responding with reassurance.

  • Recognize that non-verbal cues have a significant impact on patients with dementia. Maintaining a calm and gentle demeanor can positively influence their behavior.

  • Identify and minimize triggers for BPSD.

  • Avoid overwhelming the patient with too many staff members simultaneously.

  • Offer activities to reduce agitation and provide quiet spaces for the patient to retreat to, lessening the impact of a potentially overwhelming hospital environment.

  • Be mindful that these symptoms can stem from unmet needs like pain or discomfort.

Addressing Wandering Behavior

  • Wandering is a common concern reported by caregivers. To manage this behavior effectively, consider the following strategies:

  • Keep objects that might encourage wandering out of sight.

  • Arrange the patient's room for easy observation and safety.

  • Raise awareness among staff about the potential for wandering.

  • Encourage appropriate exercise and activity opportunities.

  • Designate safe areas for the patient to move around.

  • Maintain identification on the patient at all times.

Tackling Sundowning

  • Sundowning, characterized by restlessness and increased confusion, often occurs in the late afternoon or early evening. To address this, adopt these strategies:

  • Establish familiar early evening routines.

  • Identify calming activities or strategies with the patient's family or caregiver.

  • Facilitate safe mobility for the patient.

  • Consider environmental factors, such as lighting and noise levels.

Managing Anxiety and Agitation

Understanding the patient's perspective and validating their experience can significantly impact their well-being. Try the following strategies:

  • Engage in conversations about anxiety-inducing thoughts.

  • Offer reassurance to alleviate anxiety.

  • Identify and address the root cause of the anxiety.

Addressing Aggression

Aggressive behavior can arise due to various triggers. Employ these techniques to manage aggression:

  • Identify triggers and underlying emotions.

  • Simplify tasks and communication.

  • Use distraction or activities to diffuse situations.

  • Maintain a calm demeanor and use a soothing tone.

  • Phrase instructions positively.

Coping with Hallucinations

Hallucinations are a challenge in later stages of dementia. Employ these strategies:

  • Refrain from arguing or taking hallucinations personally.

  • Maintain a familiar environment and routine.

  • Ignore harmless hallucinations if they don't cause agitation.

  • Identify triggers and avoid them when possible.

Addressing Disinhibited Behavior

By comprehending the reasons behind disinhibited behavior, you can minimize triggers. Consider the following actions:

  • Respond with patience and a composed attitude.

  • Avoid overreaction and remember the condition's nature.

  • Reassure and comfort the person.

  • Gently guide the individual to a private setting.

  • Provide comfortable clothing.

  • Introduce alternative activities.

Pharmacological Treatment Considerations

While non-pharmacological strategies are primary, pharmacological interventions play a limited yet important role in managing BPSD.

Collaborating with Medical Professionals

  • Pharmacological interventions should be reserved for situations involving self-harm or harm to others.

  • Consult with medical professionals to determine the appropriateness of medication.

  • Monitor medication effects closely and involve geriatricians and pharmacists in the care team.

Adhering to Best Practices

  • Administer medications orally, in low doses, and for limited durations.

  • Regularly assess medication effectiveness and adjust as needed.

  • Avoid using multiple psychotropic medications concurrently.

Integrating Non-Pharmacological Approaches

  • Always combine pharmacological treatment with non-pharmacological management plans.

In conclusion, managing BPSD requires a holistic approach that encompasses both non-pharmacological and pharmacological strategies. By tailoring interventions to the individual's needs and focusing on collaboration among caregivers and medical professionals, we can enhance the well-being of patients with dementia and provide them with the best possible care.

NCLEX: National Council Licensure Examination, OIIQ: Ordre des infirmières et infirmiers du Québec, OIIAQ: Ordre des infirmières et infirmiers auxiliaires du Québec

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