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

  • Alexandra Feast (a1), Martin Orrell (a2), Georgina Charlesworth (a3), Nina Melunsky (a4), Fiona Poland (a5) and Esme Moniz-Cook (a6)...
Abstract
Background

Tailored psychosocial interventions can help families to manage behavioural and psychological symptoms in dementia (BPSD), but carer responses to their relative's behaviours contribute to the success of support programmes.

Aims

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

A systematic review and meta-ethnographic synthesis was conducted 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 people with dementia inevitably lose their ‘personhood’. Interventions for the management of challenging behaviour in family settings should acknowledge unmet psychological need in family carers.

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Copyright
This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.
Corresponding author
Alexandra Feast, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK. Email: a.feast@ucl.ac.uk
Footnotes
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Declaration of interest

None.

Footnotes
References
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Behavioural and psychological symptoms in dementia and the challenges for family carers: Systematic review

  • Alexandra Feast (a1), Martin Orrell (a2), Georgina Charlesworth (a3), Nina Melunsky (a4), Fiona Poland (a5) and Esme Moniz-Cook (a6)...
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