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Controversies in Long Term Care| Volume 19, ISSUE 2, P177-180, February 2018

The Broken Lens of BPSD: Why We Need to Rethink the Way We Label the Behavior of People Who Live With Alzheimer Disease

DOI:https://doi.org/10.1016/j.jamda.2017.11.009
The Broken Lens of BPSD: Why We Need to Rethink the Way We Label the Behavior of People Who Live With Alzheimer Disease
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      Abstract

      For the past 20 years, the behaviors of people who live with dementia (PLWD) that others find challenging or problematic have primarily been ascribed to Alzheimer disease and related dementias and have been assessed through the biomedical lens of Behavioral and Psychological Symptoms of Dementia (BPSD). This has led to the root causes of these behaviors being overlooked, which in turn leaves them unaddressed. Further, using the artificial construct of BPSD has led to many PLWD being inappropriately prescribed (off-label) medications that are largely ineffective in resolving the behaviors because they do nothing to remedy the underlying psychosocial and environmental causes. The fact that many of the behaviors we call BPSD are normal human responses to particular sets of circumstances can be relatively easily demonstrated by directly observing the individual behaviors of PWLD, and putting them in context, as well as by asking ourselves how we would respond under similar conditions. Re-evaluating the use of the construct of BPSD, and replacing it with a person-centered rather than disease-focused approach will result in better care as well as healthier and happier long-term care residents and staff.

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      References

        • Macaulay S.
        Efforts to reduce antipsychotic use in dementia care are starting to bear fruit, but a lot of work remains to be done.
        J Am Med Dir Assoc. 2017; 18: 204-206
        View in Article
        • Cohen-Mansfield J.
        • Billig N.
        Agitated behaviors in the elderly, I: A conceptual review.
        J Am Geriatr Soc. 1986; 34: 711-721
        View in Article
        • Caspi E.
        Does self-neglect occur among older adults with dementia when unsupervised in assisted living? An exploratory, observational study.
        J Elder Abuse Neglect. 2014; 26: 123-149
        View in Article
        • Schreiner A.S.
        • Yamamoto E.
        • Shiotani H.
        Positive effects among nursing home residents with Alzheimer's disease: The effect of recreation activity.
        Aging Ment Health. 2005; 9: 129-134
        View in Article
        • Casey A.N.
        • Low L.F.
        • Goodenough B.
        • et al.
        Computer-assisted direct observation of behavioral agitation, engagement, and affect in long-term care residents.
        J Am Med Dir Assoc. 2014; 15: 514-520
        View in Article
        • Feil N.
        Validation method.
        in: Feil N. de Klerk-Rubin V. The Validation Breakthrough: Simple Techniques for Communicating With People With Alzheimer's-Type Dementia. 2nd ed. Health Professions Press, Baltimore, MD2002: 21
        View in Article

      7. Macaulay S. 6 reasons why staff in long-term care facilities don't report incidents of elder abuse and neglect. Available at: http://myalzheimersstory.com/2016/10/28/6-reasons-why-staff-in-long-term-care-facilities-dont-report-incidents-of-elder-abuse-and-neglect/. Accessed November 3, 2017.

        View in Article

      8. International Psychogeriatric Association (IPA). Behavioral and Psychological Symptoms of Dementia Education Pack. Available at: http://myalzheimersstory.com/wp-content/uploads/2017/05/IPA_BPSD_Educational_Pack-1998.pdf; 1998. Accessed on November 3, 2017.

        View in Article

      9. Brill S. America's Most Admired Lawbreaker; Chapter 2; in the HuffingtonPost Highline, 2015. Available at: http://highline.huffingtonpost.com/miracleindustry/americas-most-admired-lawbreaker/chapter-2.html. Accessed November 3, 2017.

        View in Article
        • Caspi E.
        Time for change: Persons with dementia and “behavioral expressions,” not “behavior symptoms”.
        J Am Med Dir Assoc. 2013; 14: 768-769
        View in Article
        • Ray W.A.
        • Taylor J.A.
        • Liechtenstein M.J.
        • Meador K.G.
        The Nursing Home Behavior Problem Scale.
        J Gerontol. 1992; 47: M9-M16
        View in Article

      12. Nursing Home Behavior Problem Scale PDF. Available at: http://myalzheimersstory.com/wp-content/uploads/2016/04/B2-Nursing-Home-Behavior-Problem-Scale-NHBPS.pdf. Accessed November 3, 2017.

        View in Article

      13. Macaulay S. Short Survey on Behavior Results. Available at: https://www.surveymonkey.com/r/FM93TXW. Accessed November 3, 2017.

        View in Article

      14. Macaulay S. 15 tips to make Alzheimer dementia shower time successful not stressful. Available at: http://myalzheimersstory.com/2017/04/25/15-tips-to-make-alzheimer-dementia-shower-time-successful-not-stressful/. Accessed November 3, 2017.

        View in Article

      15. Macaulay S. Waging war at Alzheimer bath time. Available at: http://myalzheimersstory.com/2016/04/26/waging-war-at-alzheimers-bath-time/. Accessed November 3, 2017.

        View in Article
        • Somboontanont W.
        • Sloane P.D.
        • Floyd F.J.
        • et al.
        Assaultive behavior in Alzheimer’s disease: Identifying immediate antecedents during bathing.
        J Gerontol Nurs. 2004; 30: 22-29
        View in Article
        • Cohen-Mansfield J.
        • Mintzer J.E.
        Time for change: The role of nonpharmacological interventions in treating behavior problems in nursing home residents with dementia.
        Alzheimer Dis Assoc Disord. 2005; 19: 37-40
        View in Article
        • Cohen-Mansfield J.
        • Dakheel-Ali M.
        • Marx M.S.
        • et al.
        Which unmet needs contribute to behavior problems in persons with advanced dementia?.
        Psychiatry Res. 2015; 228: 59-64
        View in Article
        • Cohen-Mansfield J.
        • Thein K.
        • Marx M.S.
        • et al.
        Efficacy of nonpharmacologic interventions for agitation in advanced dementia: A randomized, placebo-controlled trial.
        J Clin Psychiatry. 2012; 73: 1255-1261
        View in Article
        • Cohen-Mansfield J.
        • Golander H.
        • Cohen R.
        Rethinking psychosis in dementia: An analysis of antecedents and explanations.
        Am J Alzheimers Dis Other Demen. 2017; 32: 265-271
        View in Article
        • Cohen-Mansfield J.
        • Thein K.
        • Marx M.S.
        • et al.
        Sources of discomfort in persons with dementia.
        JAMA Intern Med. 2013; 173: 1378-1379
        View in Article

      22. Dementia Action Alliance. Words Matter: SEE ME Not My Dementia (2015). Available at: https://daanow.org/wp-content/uploads/2016/03/Words_Matter-See-Me-Not-My-Dementia.pdf. Accessed November 3, 2017.

        View in Article

      23. Power A. Medicalization of Feelings: BPSD or BPSOD? Available at: https://changingaging.org/dementia/medicalization-of-feelings-bpsd-or-bpsod/. Accessed November 3, 2017.

        View in Article

      Article info

      Footnotes

      The author declares no conflicts of interest.

      Identification

      DOI: https://doi.org/10.1016/j.jamda.2017.11.009

      Copyright

      © 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

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