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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


Alexandra Feast

Martin Orrell

Georgina Charlesworth

Nina Melunsky

Fiona Poland

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Professor Esme Moniz-Cook
Emeritus Professor of Clinical Psychology of Ageing and Dementia Care Research / Dementia Research Work Group Lead


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.


Feast, A., Orrell, M., Charlesworth, G., Melunsky, N., Poland, F., & Moniz-Cook, E. (2016). Behavioural and psychological symptoms in dementia and the challenges for family carers: systematic review. British Journal of Psychiatry, 208(5), 429-434.

Journal Article Type Article
Acceptance Date Jul 14, 2015
Online Publication Date Jan 2, 2018
Publication Date 2016-05
Deposit Date Mar 9, 2016
Publicly Available Date May 31, 2016
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
Keywords Behavioural and psychological symptoms; Carers; Challenging behaviour; Dementia; Meta-ethnography; Psychosocial interventions
Public URL
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Additional Information Copy of article first published in: British journal of psychiatry, 2016, v.208, issue 5


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Copyright Statement
© Royal College of Psychiatrists, 2016

This article is made available under a CC-BY licence.

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