Title: Strategies for managing Behavioural and Psychological Symptoms in Dementia (BPSD) for community dwelling older people: evidence into practice
Funder: Department of Health (England)

Abstract: Background Over 700,000 people in the UK have dementia and two-thirds live at home. Non-cognitive behavioural and psychological symptoms of dementia (BPSD) affect up to 90% of people with dementia (PWD) and result in unrecognised distress, increased carer burden, high health and social service utilization and unwanted moves to care homes. Evidence is limited on what strategies to minimize BPSD work in community settings and what support can reduce carer strain and pre-empt the need for relocation to care homes and/or hospitalization. The Ministerial Advisory Group on Dementia Research has identified BPSD as a priority area for research and the need for an evidence base to identify effective interventions that improve outcomes for people with dementia and their carers. Moreover, improved community support and reduced use of antipsychotic drugs are part of the National Dementia Strategy. This project will conduct an integrated review in collaboration with users and practitioners through stakeholder events, and synthesise research evidence to develop guidance for effective management of BPSD that supports PWD living at home and their carers. Aims To systematically map the range of evidence for BPSD minimisation among community-dwelling people with dementia To identify effective approaches to BPSD management that can optimise activities of daily living and continuation of life at home To evaluate the evidence in terms of benefit from both people with dementia and carers' perspectives To describe the suitability of the methods used to manage BPSD for people with dementia and their carers To assess the resource implications and cost effectiveness of BPSD management interventions that improve outcomes for people with dementia To explore review findings with key stakeholders, users and carers to develop guidance for practice To make recommendations for research Plan of Investigation Having established the scope and range of the evidence on interventions to manage BPSD, in collaboration with stakeholders we will identify key areas for an in-depth analysis of what different interventions can achieve and the facilitators and inhibitors for supporting PWD at home.To help contextualise the findings from the perspectives of PWD at home, discriminate between what kind of interventions are effective with what kind of health and social care support, and identify priority research questions, focus groups will be organized with user and carer representatives and practitioners after the first stage of mapping and towards the end of the second stage of the project. Data generated from these groups will help inform recommendations and facilitate dissemination in ways that are meaningful to practitioners, PWD and commissioners of services. Potential benefits to patients and the NHS BPSD are complex in nature, associated with substantial costs and very little is known about the experiences of BPSD for PWD living at home. Evidence is required to help practitioners and carers support people in ways that address their complex needs (e.g. communication problems), and underlying causes of BPSD, for better outcomes and optimum allocation of resources by commissioners. This review will summarise the best evidence for BPSD management for community-dwelling older people. We will identify which interventions work, how they work, and at what cost and how best they can be implemented in primary and social care. We will recommend approaches that support person-centered care with potential to save costs by supporting people at home for longer, delaying or preventing the need for long-term care. The review will prevent duplication of work through identifying areas for future research. Guidelines will be developed for use by practitioners working in primary, social care and advocacy roles. Findings will outline the support, training and workforce development needed to achieve better outcomes for people with dementia.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: NEUROLOGICAL