A mixed methods exploration into the management of behavioural and psychological symptoms of dementia in care homes: care approaches, strategies and psychotropic medications

Abstract

The management of behavioural and psychological symptoms of dementia (BPSD) has gained media and policy attention recently. Antipsychotic medications have been used for these behaviours. Due to the potential risks associated with these medications the Department of Health in England has called for a reduction in their use for people with dementia. Non-pharmacological interventions have been recommended as safer alternatives. The aim of this study was to explore the strategies used in care homes to manage behavioural and psychological symptoms of dementia. The study used a mixed methods, sequential, two phase design. A postal survey of 747 care homes was conducted. The response rate for the survey was 40% (n=299). This directed purposive sampling for four in-depth case studies in care homes, which included: interviews with 40 care home staff, 384 hours of participant observations, and the mapping of 22 residents’ psychotropic medication administration records. Multiple implicit and explicit care strategies, non-pharmacological interventions, and psychotropic medications were used concurrently in care homes. Twelve percent of care home residents were reported to be prescribed at least one antipsychotic medication. Formal non-pharmacological interventions were predominantly used, and viewed, by staff as activities for all residents and not targeted at the management of behaviours. The risks and impacts of behaviours posed challenges for care staff. Person-centred care was difficult to provide consistently. This thesis provides an important examination of the strategies that care workers have adopted, developed and implemented to manage behavioural and psychological symptoms of dementia in care homes. The findings portray a gap between rhetoric and practice, with implicit care strategies (some questionable) and perceived usual care approaches employed more than formal non-pharmacological interventions. A theoretical contribution is made by problematising the delivery of person-centred care in communal settings where care workers must constantly negotiate competing demands, risks and organisational constraints