Researchers from the Dementia Centre for Research Collaboration (DCRC) at UNSW Sydney have shown that non-pharmacological approaches can not only reduce behaviours and psychological symptoms associated with dementia (BPSD*), but also that they are cost-effective.
The commentary, published in International Psychogeriatrics , highlights the current difficulties in sustaining use of these approaches in the long term due to concerns about costs and lack of sufficient training, support, time and resources across care staff.
Lead author and Research Fellow at the DCRC, Dr Claire Burley, explains cost analyses associated with individual BPSD and demonstration of cost-effectiveness of non-pharmacological approaches are becoming more common in research.
"Our biggest challenge is implementing evidence into practice,” says Dr Burley.
Care managers and policy makers need to be informed of evidence showing clinical and cost-effectiveness of non-pharmacological approaches.
Dr Burley suggests this notion is increasingly concerning given the current COVID-19 pandemic.
“Chemical restraint (excessive use of medication ) is already a major issue in Aged Care. This was highlighted in the Commonwealth’s recent Royal Commission into Aged Care Quality and Safety. Concerns have been expressed that older people with COVID-19 who are or those with dementia living in care are being sedated to prevent moving around and cross infection,” says Dr Burley.
Globally, the social and economic costs of dementia have rapidly escalated in recent years; which is related to ageing of the population and BSPD including depression, agitation and aggression. This research clearly demonstrates that other non-pharmacological strategies - which are both clinically effective and cost-effective - are available to reduce BPSD.
“With this research we particularly wanted to address whether the economic benefits of non-pharmacological approaches in preventing and managing BPSD outweigh the costs,” says Dr Burley.
“Non-pharmacological approaches include person-centred care, education and training, physical activity and music therapy,” says Dr Burley.
A change in attitudes is required in care practice with the support from managers and policy makers, in addition to the appropriate training for care staff, to ensure these measures are adopted long-term.
Co-author, Director of the DCRC and Co-Director of the Centre for Healthy Brain Ageing (CHeBA), Professor Henry Brodaty, emphasises that clinicians should implement non-pharmacological practices promptly, given the person-centred and fiscal benefits.
Economically, socially and clinically, it’s time to invest in prevention and better care of behaviours and psychological symptoms associated with dementia, says Professor Brodaty.
This research has the potential to encourage professional and family caregivers to provide non-pharmacological approaches of care to care recipients and loved ones impacted by dementia.
Future research incorporating cost-benefit analyses into intervention and implementation studies would be beneficial to build on this area and ultimately improve the quality of life for people living with dementia.
Dr Burley will be presenting more on this topic at the Virtual Alzheimer’s Association International Conference (AAIC) in July 2020.
‘Behaviours and psychological symptoms associated with dementia (BPSD)’ is used respectfully for communication between professionals, people living with dementia and families ( see Cunningham et al. 2019, IJGP). For more information about preferences on terminology, please consult the Dementia Language Guidelinesproduced by Dementia Australia.