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bpsd

Behavioural and Psychological Symptoms of Dementia (BPSD)

introduction

  • BPSD is a collection of observed behaviours and psychological symptoms that tend to occur together in a person with dementia
  • BPSD typically presents in the later stages of dementia, with 60–90% of people with dementia presenting with at least one BPSD during the course of the disease
  • frequency of BPSD increases with the severity of dementia.
  • BPSD is associated with carer stress, increased duration of hospitalisation and greater likelihood of placement in a residential aged care facility
  • BPSD includes:
    • verbal agitation - aggressive and non-aggressive
    • physical agitation - aggressive and non-aggressive
    • psychosis
    • apathy
    • depression
    • anxiety
    • inappropriate sexual behaviour
      • implied
      • non-aggressive
      • intrusive
      • aggressive

Mx of acute "emergency" BPSD

  • any situation in which the physical safety of the person, carers and other patients is potentially seriously compromised is considered an emergency
  • it is essential to consider the cause of the behaviour – such as:
    • unmet needs
    • pain
    • urinary retention
  • use non-pharmacological actions to prevent the behaviour escalating:
    • prevent self-harm, such as keeping the person away from open windows, balconies, electric cords and other equipment
    • remove from the immediate environment others who may be at risk
    • move the person so that continuous direct observation is possible, or to a secure unit where available
    • involve family or other carers
    • consider one to one staffing
    • in the ED, physical restraint may be the safest option to prevent harm to the patient and others
    • remember that the person with dementia will be afraid and confused
  • ensure that all staff are aware of local policies and procedures for responding to behavioural emergencies
  • acute sedation may be considered only if essential to immediately reduce risks to the person, other patients and staff in the immediate environment
    • generally oral sedation should be tried first such as:
      • o lorazepam 0.5-1.25mg (max. 7.5mg/24hrs)
      • s/l olanzapine 2.5-5mg (max. 10mg/24hrs)
      • o risperidone 0.5-1mg (max. 4mg/24hrs)
    • if fails, and there is no evidence of delirium, consider im olanzapine 2.5mg (up to 7.5mg)
      • AVOID within 2hrs of parenteral benzodiazepines as risk of resp. depression
bpsd.txt · Last modified: 2014/12/06 17:06 (external edit)