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Behavioural and psychological symptoms in dementia and the challenges for family carers: systematic review

Feast, Alexandra; Orrell, Martin; Charlesworth, Georgina; Melunsky, Nina; Poland, Fiona; Moniz-Cook, Esme

Abstract

Background Tailored psychosocial interventions can help families to manage behavioural and psychological symptoms in dementia (BPSD), but carer responses to their relatives’ behaviours contribute to the success of support programmes. Aim To understand why some family carers have difficulty in dealing with BPSD, in order to improve the quality of personalised care that is offered. Method Systematic review and meta-ethnographic synthesis of high quality quantitative and qualitative studies between 1980 and 2012. Results We identified 25 high quality studies and two main reasons for behaviours being reported as challenging by family carers: changes in communication and relationships resulting in ‘feeling bereft’; and perceptions of transgressions against social norms associated with ‘misunderstandings about behaviour’ in the relative with dementia. The underlying belief that their relative had lost, or would inevitably lose, their identity to dementia was a fundamental reason why family carers experienced behaviour as challenging. Conclusions Family carers’ perceptions of BPSD as ‘challenging’ are associated with a sense of a ‘declining relationship’, transgressions against social norms, and underlying beliefs that their relative would inevitably lose their ‘personhood’. Interventions for the management of challenging behaviour in family settings should acknowledge unmet psychological need in family carers.

Journal Article Type Article
Publication Date 2016-05
Journal British journal of psychiatry
Print ISSN 0007-1250
Electronic ISSN 1472-1465
Publisher Royal College of Psychiatrists
Peer Reviewed Peer Reviewed
Volume 208
Issue 5
Pages 429-434
DOI https://doi.org/10.1192/bjp.bp.114.153684
Keywords Behavioural and psychological symptoms; Carers; Challenging behaviour; Dementia; Meta-ethnography; Psychosocial interventions
Publisher URL http://bjp.rcpsych.org/content/early/2016/03/10/bjp.bp.114.153684
Copyright Statement © Royal College of Psychiatrists, 2016

This article is made available under a CC-BY licence.
Additional Information Copy of article first published in: British journal of psychiatry, 2016, v.208, issue 5

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