People with dementia usually experience behavioural and psychological symptoms of dementia (BPSD) during the course of their illness. Currently, in Australia, there is a lack of comprehensive planning for managing and preventing BPSD, and the resources required for optimal care are inadequate and unevenly distributed.
We propose a seven-tiered model of service delivery based on severity and prevalence of BPSD, ranging from no dementia through tiers of increasingly severe behavioural disturbance to the propensity for extreme violence in a small number of individuals.
Each tier is associated with a different model of intervention. People with dementia may move up or down between tiers depending on their condition, their care and the intervention provided.
Lower-level interventions may prevent the need for the more intensive interventions needed when disturbance becomes more severe.
- 1. Jorm AF. Dementia: a major health problem for Australia. Canberra: Alzheimer's Association Australia, September 2001. Position Paper 1.
- 2. Lyketsos CG, Steinberg M, Tschanz JT, et al. Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. Am J Psychiatry 2000; 157: 708-714.
- 3. Mega MS, Cummings JL, Fiorello T, Gornbein J. The spectrum of behavioral changes in Alzheimer's disease. Neurology 1996; 46: 130-135.
- 4. Snowdon J, Miller R, Vaughan R. Behavioural problems in Sydney nursing homes. Int J Geriatr Psych 1996; 11: 535-541.
- 5. Brodaty H, Draper B, Saab D, et al. Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors. Int J Geriatr Psychiatry 2001; 16: 504-512.
- 6. Sourai R, McCusker J, Cole M, Abrahamowicz M. Agitation in demented patients in an acute care hospital: prevalence, disruptiveness and staff burden. Int Psychogeriatr 2001; 13: 183-197.
- 7. Pearson JL, Teri L, Reifler BV, Raskind MA. Functional status and cognitive impairment in Alzheimer's patients with and without depression. J Am Geriatr Soc 1989; 37: 1117-1121.
- 8. Brodaty H. Caregivers and behavioural disturbances: effects and interventions. Int Psychogeriatr 1996; 8: 455-458.
- 9. Rodney V. Nurse stress associated with aggression in people with dementia: its relationship to hardiness, cognitive appraisal and coping. J Adv Nurs 2000; 3: 172-180.
- 10. Moore MJ, Zhu CW, Clipp EC. Informal costs of dementia care: estimates from the National Longitudinal Caregiver Study. J Gerontol B Psychol Sci Soc Sci 2001; 56(4): S219-S228.
- 11. Herrmann N, Black SE. Behavioral disturbances in dementia. Will the real treatment please stand up? Neurology 2000; 55: 1247-1248.
- 12. White L, Parrella M, McCrystal-Simon J, et al. Characteristics of elderly psychiatric patients retained in a state hospital during downsizing: a prospective study with replication. Int J Geriatr Psychiatry 1997; 12: 474-480.
- 13. Gelber H. The experience of the Royal Children's Hospital Mental Health Service teleconferencing project. J Telemed Telecare 1998; 4(Suppl 1): 71-73.
- 14. Draper B, Brodaty H, Low L-F, et al. Use of psychotropics in Sydney nursing homes: associations with psychosis, depression and behavioural disturbances. Int Psychogeriatr 2001; 13: 107-120.
- 15. Jorm AF. Prospects for the prevention of dementia. Australas J Ageing 2002; 21(1): 9-13.
- 16. Wilson RS, Mendes de Leon CF, Barnes LL, et al. Participation in cognitively stimulating activities and risk of incident Alzheimer disease. J Am Geriatr Soc 2002; 287: 742-748.
- 17. Fabrigoule C, Letenneur L, Dartigues JF, et al. Social and leisure activites and risk of dementia: a prospective longitudinal study. J Am Geriatr Soc 1995; 43: 485-490.
- 18. Friedland RP, Fritsch T, Smyth KA, et al. Patients with Alzheimer's disease have reduced activities in midlife compared with healthy control-group members. Proc Natl Acad Sci U S A 2001; 98: 3440-3445.
- 19. Tariot PN, Solomon PR, Morris JC, et al. A 5-month, randomized, placebo-controlled trial of galantamine in AD. The Galantamine USA-10 Study Group. Neurology 2000; 54: 2269-2276.
- 20. Brodaty H, Gresham M, Luscombe G. The Prince Henry Hospital Dementia Caregivers' Training Programme. Int J Geriatr Psychiatry 1997; 12: 183-192.
- 21. Alzheimer's Association Australia. Living with memory loss. Available at: http://www.alzheimers.asn.au/OurServices/osfie.html (accessed Dec 2002). Follow links to Support, Living with memory loss.
- 22. Teri L, Logsdon RG, Uomoto J, McCurry SM. Behavioral treatment of depression in dementia patients: a controlled clinical trial. J Gerontology B Psychol Sci Soc Sci 1997; 52(4): P159-P166.
- 23. Haupt M, Karger A, Janner M. Improvement of agitation and anxiety in demented patients after psychoeducative group intervention with their caregivers. Int J Geriatr Psychiatry 2000; 15: 1125-1129.
- 24. Proctor R, Burns A, Powell HS, et al. Behavioural management in nursing and residential homes: a randomised controlled trial. Lancet 1999; 354: 28-29.
- 25. Teri L, Logsdon RG, Peskind E, et al. Treatment of agitation in AD: a randomized, placebo-controlled clinical trial. Neurology 2000; 55: 1271-1278.
- 26. Opie J, Rosewarne R, O'Connor DW. The efficacy of psychosocial approaches to behaviour disorders in dementia: a systematic literature review. Aust N Z J Psychiatry 1999; 33: 789-799.
- 27. Tariot PN, Ryan JM, Porsteinsson AP, et al. Pharmacologic therapy for behavioral symptoms of Alzheimer's disease. Clin Geriatr Med 2001; 17: 359-76.
- 28. Draper B. Consultation liaison geriatric psychiatry. In: Melding P, Draper B, editors. Geriatric consultation liaison psychiatry. New York: Oxford University Publications, 2001: 3-34.
- 29. Banerjee S, Shamash K, Macdonald AJD, Mann AH. Randomised controlled trial of effect of intervention by psychogeriatric team on depression in frail elderly people at home. BMJ 1996; 313: 1058-1061.
- 30. Rovner B, Steele C, Shmuely Y, Folstein MF. A randomized trial of dementia care in nursing homes. J Am Geriatr Soc 1996; 44: 7-13.
- 31. Kunik ME, Ponce H, Molinari V, et al. The benefit of psychiatry hospitalization for older nursing home residents. J Am Geriatr Soc 1996; 44: 1062-1065.
- 32. Wiener PK, Kiosses DN, Klimstra S, et al. A short-term inpatient program for agitated demented nursing home residents. Int J Geriatr Psychiatry 2001; 16: 866-872.
- 33. King R, Abel B. Hilltop Lodge: an evaluation of the first fifteen months of the CADE unit, Tamworth. Aust Clin Rev 1991; 11: 87-91.
- 34. Gordon R. An operational definition of prevention. Public Health Rep 1983; 98: 107-109.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.