Behavioural and Psychological Symptoms of Dementia (BPSD) – Why Ban It

Following on from yesterdays article Behavioural and Psychological Symptoms of Dementia (BPSD) – What Is It, this article moves on to the medical model of BPSD and why it should be banned.

Let me state from the outset reader, that the campaign to Ban BPSD in no way advocates the complete removal of antipsychotics.

As with any other chronic terminal disease they do have a place but the campaign wants to see healthcare systems move from the medical model which on further reading you will see that it abuses the person with Dementia and ignores their human rights, to the social model that treats the causes.

Currently, healthcare systems follow the medical model of BPSD which leads to the pathway of Chemical Restraint, Deprivation of Liberty and Involuntary Care.

The medical model treats the symptoms of BPSD usually by Chemical Restraint which leads to increase clusters of behaviours associated Dementia.

During nearly 20 years working in healthcare I saw many people living with Dementia given 0.5mg of Haloperidol/Haldol only for the person to disappear within 48 hours, unable to do the basic activities of daily living (ADLs), the person and quality of life gone.

The NICE/SCIE guideline “Antipsychotics in people with Dementia”                                   Last updated : 

“Advises against the use of any antipsychotics for non-cognitive symptoms or challenging behaviour of dementia unless the person is severely distressed or there is an immediate risk of harm to them or others. Any use of antipsychotics should include a full discussion with the person and carers about the possible benefits and risks of treatment.

In the May 2012 edition of Drug Safety Update, the MHRA advised that no antipsychotic (with the exception of risperidone in some circumstances) is licensed in the UK for treating behavioural and psychological symptoms of dementia. However, antipsychotics are often prescribed off-label for this purpose.”

Many pathways advocate reducing Polypharmacy that may contribute to BPSD but they do not advocate replacing them with alternatives. Polypharmacy refers to a person taking 5 or more different types of medication, surely ready they wouldn’t have been prescribed if they weren’t needed.

Removing medications without replacement may cause clusters of BPSD because symptoms of a pre-existing condition return causing distress to the person.

A social model  is concerned with treating the causes of behaviours, reducing the need for Chemical Restraint, Deprivation of Liberty and Involuntary Care. It enables  people to continue to live with their Dementia’s for longer, reducing the need for safeguarding, involuntary care, being moved to a Care Home and respects the persons rights to live their life without restraint.

A lot of pathways include the different types of Mental State Examinations and Cognitive Assessments which are subjective tests that only provide a snapshot of a moment in time and are subject to variations based on the time of day, and many of the causes of BPSD.

Some of the potential causes of behaviours in Dementia are:

  • Urinary Tract Infection (UTI)
  • Constipation
  • Hot/Cold
  • Pain
  • Noise
  • Environment
  • Not Recognising People/Places
  • Hunger/Thirst
  • Fear
  • Apathy
  • Regressing to a Different Time
  • Boredom/Loneliness
  • Lack of Meaningful Activities

which require proper assessment and treatment/strategies rather than antipsychotic medication.

Alzheimer’s Association : Challenging Behaviours

“Following representations by Dementia Alliance International and Alzheimer’s Disease International, the CRPD Committee has responded to our joint request to make it clear to Member States that persons with dementia and their care partners are fully included in the implementation of the CRPD on the same basis as those with other disabilities.

In 2017, dementia has been specifically mentioned in the review process on Canada and in a Parallel Report submitted by Disability Rights UK in the ongoing review of the UK government. Dementia is now described in UN documents as a cognitive disability.

The use of the model of BPSD, can be a treatment of convenience that makes it easier to care for a person with Dementia but it’s effect is the removal of the person, their quality of life and their rights.

Using a social model to treat the causes/symptoms of Dementia can empower the person living with Dementia, retain the person and uphold their rights..

Dementia isn’t a mental health condition, it is a cognitive disability. Dementia is an umbrella term for over 100 chronic terminal neurological diseases which have a physical cause.

Obviously, as with any chronic terminal disease, there will be a minority that may require the intervention of a mental health professional and possibly pharmacological interventions during their journey with their disease but only after treating the causes of behaviours to improve their quality of life, using the social model, has failed.

The social model should recognise Dementia as a cognitive disability and begin at the point of diagnosis with state funded, inclusive rights based post-diagnosis support and services which continue along their journey with Dementia, regardless of age at diagnosis and in line with the UN Declaration of Human Rights and the Convention on the Rights of Persons with Disabilities (CRPD).

Further comment will be tomorrow in my Sunday Musings

I’ll leave you reader with

Leah Bisiani, MHlthSc, Dip Bus, dementia and aged care consultant, RN.1
Kate Swaffer, human rights activist, author, MSc dementia care, PhD candidate
Daniella Greenwood, consultant, author, speaker, activist
Dr Chris Alderman, B Pharm, PhD, FSHP, BCPP, CGP
Dr Al Power, Geriatrician, author, educator
Susan Macaulay, care partner, author, dementia advocate

who write an Open Letter to Gabriella Rogers and Channel 9, Australia


Resources

Beyond the Medical Model: The Culture Change Revolution in Long-Term Care

The social model of disability

Dementia, rights, and the social model of disability

Care planning, involvement and person-centred care

The NICE/SCIE guideline “Antipsychotics in people with Dementia

Haloperidol/Haldol

What is Polypharmacy ?

NHS Scotland : Stopping Antipsychotics in Patients with Dementia

Safe Prescribing in Dementia

Alzheimer’s Association : Challenging Behaviours

 

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