Personal care plans, not drugs, best for people living with dementia experiencing severe behaviours

A world-first study of people living with severe symptoms of dementia has discovered that the impact of non-drug psychosocial treatments are more effective and significantly improve quality of life. 

Stephen Macfarlane personal care

A world-first study of people living with severe symptoms of dementia has discovered that the impact of non-drug psychosocial treatments are more effective and significantly improve quality of life.

The population-based study examined the impact of non-drug psychosocial treatments on nearly 6000 people living with severe symptoms of dementia. 

The study, based on referrals for non-pharmacological interventions to Dementia Support Australia (DSA), has found these interventions to be highly clinically effective in managing behaviours and psychological symptoms of dementia (BPSD), based on behaviour outcome measures.

These findings follow the Aged Care Royal Commission’s final report recommending a range of actions to improve the quality of care for people living with dementia  

The Royal Commission heard disturbing evidence that people living with dementia in residential aged care homes are frequently inappropriately prescribed psychotropic medication, often a form of chemical restraint.

Dementia affects at least 50% of the 200,000 people living in residential aged care homes.  

The study, Evaluating the Clinical Impact of National Dementia Behaviour Support Programs on Neuropsychiatric Outcomes in Australia, confirms that most – if not all – BPSD can be most effectively supported by non-pharmacological interventions.

The Australian Non drug care better dementia Stephen Lunn newspaper article

BPSD includes distressing symptoms such as agitation and aggression, abnormal motor behaviour, anxiety, delusions, hallucinations and disinhibition.

The authors describe the study as the first and largest population-based study in the world to report on behaviour outcomes in people living with dementia after broad program-based psychosocial interventions. It involved studying 5914 referrals from 1996 nursing homes across Australia.

The study looked at behaviour outcomes as measured by pre- and post-treatment scores on the Neuropsychiatric Inventory (NPI), a validated tool for measuring behaviours in dementia. There were significant reductions in total NPI scores of between 61.2% and 74.3%.

This contrasts with an average reduction (using the same instrument) of around 8% when antipsychotic medications have been studied for the same purpose.

DSA Head of Clinical Services A/Prof Stephen Macfarlane, lead study author, said the findings confirm that psychosocial/non-pharmacological therapies are the “gold standard” for interventions. He said evidence suggests up to 44% of Australia’s aged care residents are on antipsychotic drugs, and that much of this prescribing is ineffective.

“Estimates are that only 10% of this prescribing is appropriate,” Macfarlane said. “It is often the case there is a lack of efficacy and high rates of adverse effects, including falls, sedation and death.”

Since 2016, DSA programs funded by the Australian Government have provided rapid, comprehensive and intensive dementia-specific in-reach services to aged care homes to help aged care residents living with dementia. 

DSA programs work collaboratively with primary caregivers of a person living with dementia and other medical specialists to assess their personal history and surroundings and the impact on their quality of life.

Consultants outline factors that contribute to behaviours and recommend actions to eliminate or reduce these factors and their impact on BPSD. For example, undiagnosed pain may be a factor.

HammondCare Chief Executive Mike Baird said the study was a “game-changer” for how BPSD should be treated in residential aged care services. “The evidence is in that for the overwhelming number of people living with dementia experiencing BPSD, the best approach is tailored psychosocial care strategies,” Baird said.