An evaluation of the effectiveness of a case-specific approach to challenging behaviour associated with dementia†

†Dedication: in grateful memory of Ailsa Korten.

Abstract

Objectives: Treatment of challenging behaviour in dementia using standardized psychopharmacological or psychosocial approaches remains problematical. A case-specific approach was trialled in this study, based on extensive evidence that each case is different in aetiology, the effects of the behaviour on others and what interventions are possible given the available resources.

†Dedication: in grateful memory of Ailsa Korten.

Method: Forty-four consecutive referrals for challenging behaviour (two-thirds in residential care) were assessed across multiple causal domains. Both assessment and development of interventions were undertaken in collaboration with family carers and care staff. Measures of behaviour and associated carer distress, as well as medication and service use, were taken pre-intervention and at 2- and 5-month follow-ups.

Results: Psychotropic medication was used with a minority of participants but, overall, antipsychotic use was reduced. Psychosocial methods predominated, with 77% of cases judged as mainly or entirely psychosocial by an expert panel. There were significant mean improvements in behaviour and carer distress. Using conservative criteria there was a 65.9% clinical success rate.

Conclusion: Results confirm those of other studies which have used multifaceted interventions tailored to the unique needs of each case. They compare favourably with results from trials of standardized psycho-pharmacological or psychosocial approaches. More trials are needed, necessarily involving further development of robust methodologies which reflect the case-specific nature of challenging behaviour associated with dementia.

Keywords:

• Behavioural and Psychological Symptoms of Dementia (BPSD)
• biopsychosocial assessment
• psychosocial methods
• carer distress
• residential care
• tailored interventions

Acknowledgements

We express our profound gratitude to the people with dementia and their carers who took part, and the Australian Government Department of Health and Ageing, whose funding made this study possible. Heather Smithers contributed to the study planning, collected data and co-ordinated data collection by others, and checked data entry. Other clinicians involved in the interventions were Maureen Stronach and Karen Cohen, assisted on a few cases by Kris Revson and Lucy O’Neill. Sue Kurrle and Ian Cameron provided geriatrician input where required. Sandra Faase assisted with study administration and data collection. Jasmine Cohen entered the data. Thanks are also due to Annaliese Blair, Terri Davis, Katrina Anderson and Sarah MacPherson, who assisted in various ways in preparation of this manuscript.

Notes

†Dedication: in grateful memory of Ailsa Korten.