Primary behaviours varied between Dementia Support Australia’s behaviour support programs
The Dementia Behaviour Management Advisory Service (DBMAS) is a program designed to provide proactive support early on, where there is less risk related to behaviour. For people living with dementia who are experiencing severe behaviour and psychological symptoms, the Severe Behaviour Response Team (SBRT) is recommended.
Between July 2021 and June 2022, clients assessed for DBMAS and SBRT varied in primary behaviour. Almost 84% of primary behaviours assessed in SBRT referrals recorded physical aggression (63%) or agitation (21%) as a primary behaviour. While physical aggression and agitation were also the leading recorded primary behaviours within DBMAS assessments, they accounted for a lower proportion (combined 56%) of primary behaviours recorded.
|
DBMAS
|
SBRT
|
Agitation
|
36.4
|
20.7
|
Physical Aggression
|
19.4
|
63.1
|
Verbal Aggression
|
12.0
|
5.2
|
Anxiety
|
7.1
|
1.0
|
Aberrant Motor Behaviour
|
3.8
|
1.7
|
Delusions
|
3.3
|
0.8
|
Nighttime Behaviour
|
3.3
|
0.6
|
Irritability/ Lability
|
3.2
|
0.8
|
Physical Sexual Behaviour
|
2.8
|
3.9
|
Depression/ Dysphoria
|
2.6
|
0.8
|
Disinhibition
|
1.8
|
0.7
|
Apathy/ Indifference
|
1.7
|
0.1
|
Hallucinations
|
1.5
|
0.6
|
Appetite and Eating
|
1.1
|
0
|
Elation/ Euphoria
|
0
|
n.p.
|
Note: n.p. – Not available for publication. Estimate is considered to be unreliable.
Source: Dementia Support Australia 2022
Severe BPSD requires specialist care
Although rare, BPSD can be severe enough that highly specialised care is needed above that provided by SBRT. For clients requiring specialist accommodation, care and support, the Needs Based Assessment Service (NBA) is recommended to assess eligibility for Specialist Dementia Care Program (SDCP) placement. As the prevalence of people experiencing BPSD decreases as severity of the symptoms increase, there is a much smaller number of NBA referrals when compared with the SBRT and DBMAS programs. Between September 2019 and June 2022, a total of 525 NBA referrals were assessed.
The NBA program assesses eligibility with three key principles:
- Behaviours and psychological symptoms are primarily the result of dementia.
- Symptoms are severe or very severe.
- Symptoms have remained non-responsive to adequate trials of treatment, including non-pharmacological interventions and other specialist programs.
Assessments may be rated ineligible for a number of reasons, including severity not being evaluated as high enough. Conversely, assessments may be rated as ineligible due to behaviours being too severe for Specialist Dementia Care Program (SDCP) placement. Of the referrals between September 2019 and June 2022, 31% were rated ineligible. Of these, around a quarter were rated ineligible due to extreme behaviours.
Overall Neuropsychiatric Inventory (NPI) scores improved following engagement with programs
While the information presented above focuses on the primary behaviour clients present with, clients can experience multiple behaviours at once. Between January 2022 and June 2022 DSA clients presented with behaviour symptoms in an average of 5.4 domains out of the 12 NPI domains upon program intake, and 3.0 upon program exit (an overall reduction of 44%) (Table 15.2). This decrease demonstrates the effectiveness of tailored services for BPSD management, and supports findings from a 2021 evaluation on the clinical impact of these programs on neuropsychiatric outcomes (Macfarlane et al. 2021).
Other measures included in the NPI are total severity of behaviours and total distress/disruptiveness of behaviours to formal and informal carers. The average total severity score decreased between clients who were referred to a program compared to clients who were discharged from a program within the six-month period (11.2 compared with 4.4, respectively) (Table 15.2). Similarly, the average total distress score among carers at intake between January 2022 and June 2022 was 15.2, dropping to 5.3 among carers at exit from the program.
|
Intake
|
Discharge
|
Number of domains
|
5.4
|
3.0
|
Total distress
|
15.2
|
5.3
|
Total severity
|
11.2
|
4.4
|
Source: Dementia Support Australia 2022
While DSA aims to provide support for people with dementia and their carers, programs also aim to support residential aged care homes in their support of people experiencing behavioural symptoms. Between January 2022 and June 2022, DSA had an average of 3.5 client referrals per residential aged care home in Australia and provided support to 1,674 (61%) residential aged care homes in Australia.