Assessment and Management of People with Behavioural and ...

1 SAssessment and Management of People with Behavioural and Psychological Symptoms of Dementia (BPSD)A Handbook for NSW Health CliniciansNSW MINISTRY OF HEALTH 73 Miller Street NORTH SYDNEY NSW 2060 Tel. (02) 9391 9000 Fax. (02) 9391 9101 TTY. (02) 9391 9900 by:The Royal Australian & New Zealand College of Psychiatrists Tel. (03) 9640 0646 Fax. (03) 9642 5652 Email. work is copyright. It may be reproduced in whole or in part for study or training purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale.

2 Reproduction for purposes other than those indicated above requires written permission from the NSW Ministry of Health. NSW Ministry of Health 2013 SHPN (MHDAO) 130007 ISBN 978-1-74187-907-0 For further copies of this document please contact: The Better Health Centre PO Box 672 NORTH RYDE 2113 Tel. (02) 9887 5450 Fax. (02) 9887 5452 Further copies of this document can be downloaded from the NSW Health website or the Royal Australian & New Zealand College of Psychiatrists website 2013A publication by the NSW Ministry of Health and the Royal Australian and New Zealand College of Psychiatrists May 2013 Assessment and Management of People with Behavioural and Psychological Symptoms of Dementia (BPSD) NSW HeAltH PAGe iHandbook Overview.

3 IiiAudience ..ivSettings ..ivKey principles ..ivClinical vignettes ..ivPriorities ..vThe cycle of care ..vKey clinician roles ..viKey communication points ..viiiConsumer and carer resource ..viiiChapter structure ..viiiSummary of figures and tables ..ixChapter 1 The basics: Principles, priorities and cycle of care ..1 Introduction ..1 Key principles ..2 Priorities ..2 The cycle of care ..3 Further resources ..4 Chapter 2 Accept: Overview of dementia and BPSD ..5 Overview of dementia ..5 Types of dementia ..6 Stages of dementia ..6 Behavioural and psychological symptoms of dementia.

4 6 References ..10 Further resources ..10 Chapter 3 Accept: Person-centred care, communication and working with the carer ..11 Communication ..12 Maximise residual strengths in the person ..14 Work with the carer ..14 References ..15 Further resources ..15 Chapter 4 Assess: Assessment of the person with BPSD ..17 Assess the person ..19 Safety ..21 Communication ..22 The environment ..22 Psychosocial factors and psychiatric disorder ..23 Further resources ..24 Chapter 5 Act I: Non-pharmacological and psychosocial Management ..25 Maintain safety ..25 Modify the environment.

5 26 Modify activities ..26 Specific treatments ..28 Other non-pharmacological considerations ..31 References ..32 Further resources ..33 Chapter 6 Act II: Pharmacological Management ..35 PBS indications ..36 References ..37 Further resources ..39 Chapter 7 Emergency care ..41 Consent ..41 Medication ..41 References ..42 Further resources ..42 Chapter 8 Legal and ethical considerations ..43 Determining capacity to consent ..43 Principles of capacity Assessment ..43 When capacity is not present ..44 Person responsible ..46 Special treatment ..47 Further resources.

6 48 Chapter 9 Accept: Roles in care of differing professional disciplines, teams and settings ..49 Multiple teams and settings ..53 Team approach to coordinating care ..53 Care in emergency departments ..54 Care in the in-patient ward ..55 Care in community settings ..56 References ..57 Further resources ..57 Glossary ..58 ContentsPAGe ii Assessment and Management of People with Behavioural and Psychological Symptoms of Dementia (BPSD) NSW HeAltHAssessment and Management of People with Behavioural and Psychological Symptoms of Dementia (BPSD) NSW HeAltH PAGe iiiAppendicesAppendix 1.

7 Rating scales/measurement tools ..59 Appendix 2. Clinical support and NSW community Services ..62 Appendix 3. Project methodology and consultation ..67 Assessment and Management of People with Behavioural and Psychological Symptoms of Dementia (BPSD) NSW HeAltH PAGe iiiThe person with dementia will experience a good quality of life for long periods, but may also experience Behavioural and psychological symptoms associated with dementia (BPSD). When BPSD is present, People require care across multiple settings and NSW Health teams. BPSD may be the focus of care or at other times a co-morbid issue requiring Management .

8 In either situation, the person with BPSD and their carers should receive high-quality care with a consistent underlying approach to BPSD. This Handbook aims to provide both a reference point and practical resource to assist NSW Health staff to meet this Handbook frameworkThere are many useful resources for clinicians providing care for People experiencing BPSD. This Handbook has been designed using a framework to meet specific requirements with several distinguishing features. These are presented in Figure 1 and further resources are included at the end of each chapter.

9 A bibliography and list of website resources can also be found at the end of the Handbook (pages 69 -73).Handbook overviewFigure 1. Main features of BPSD handbookConsumer Guidetables & ChartsCycle of CareAudienceSettingsKey PrinciplesClinical VignettesPrioritiesBPSD FrameworkPAGe iv Assessment and Management of People with Behavioural and Psychological Symptoms of Dementia (BPSD) NSW HeAltHAssessment and Management of People with Behavioural and Psychological Symptoms of Dementia (BPSD) NSW HeAltH PAGe vAudience: NSW Health clinical staff The Handbook is intended to be a practical handbook and ready reference for NSW Health staff working in settings where they will care for People with dementia and BPSD.

10 Given the wide variety of expertise, disciplines and roles of staff within NSW Health, it is not possible to capture the extent of specialist practice that may be applied by expert practitioners across these disciplines and settings. Therefore, this Handbook may be used in a variety of ways. For less experienced staff it provides an overview of key concepts and practical resources that they may apply and discuss with their supervisors. More experienced staff may use it as a refresher or teaching resource, and multidisciplinary teams as a common reference point to assist in coordinated care.