In their 2018 study, Song et al. found that behavioral and psychological symptoms of dementia (BPSD) depended on the interaction style and complex interplay between individual's with dementia and their family caregivers. Their findings suggest that a positive change in caregiver attitudes and use of modified approaches may help address BPSD.
Behavioral and Psychological Symptoms of Dementia (BPSD)
The authors define BPSD as "symptoms of disturbed perception, thought content, mood, or behavior" (p. 13). Researchers estimate that 80-90% of individuals with dementia experience at least one BPSD, increasing in prevalence as the disease progresses. BPSD are observed as:
- Unreal thoughts and perceptions (i.e., delusions, hallucinations)
- Emotional dysregulation (i.e., increased agitation, anxiety, irritability, depression, apathy, elation, disinhibition)
- Inappropriate behavior (i.e., social challenges, changes in sleep and appetite, abnormal motor function)
- Decrease in cognition (i.e., memory, decision making)
External factors contributing to the severity of BPSD include internal attributes (e.g., illness, pain, fatigue, bodily discomfort, pharmacological side effects), external attributes (e.g., home environment, weather, temperature, daylight hours), and interpersonal attributes (i.e., social interactions, contextual information, emotional affect).
As behaviors can indicate an unmet need in individuals with dementia, their interactions with caregivers can critically impact the persistence and severity of symptomology. Notably, a caregiver's negative disposition can trigger interpersonal conflict, which may exacerbate BPSD.
Research Findings
The authors identified several contributing factors for activating BPSD (Table 2, p. 19):
| Patient-related factors | Caregiver-related factors |
|---|---|
| Realizing their loss of power | Lack of knowledge |
| Failing to understand the situation | Lack of consideration |
| Expressing their needs in their own manner | Instilling fear in patient |
| Ignoring patient’s needs |
In response to BPSD, Song et al. (2018) identified a positive correlation between caregiver actions and patient reactions (Table 3, p. 21):
| Caregiver's actions towards BPSD | Action score | Patient-reaction codes | Patient-reaction legend* |
|---|---|---|---|
| Giving a response | +3 | (1) (2) | (1) Being calmed down (+2) |
| Preventing cause of the behavior | +3 | (1) (2) | (2) Stopping behavior (+1) |
| Distracting | +2 | (2) (1) (3) (4) | (3) Resisting caregiver’s request (+/-0) |
| Pacifying | 0 | (4) (1) (2) (5) | (4) Continuing the same behavior (-1) |
| Asking others for help | 0 | (2) (4) | (5) Losing one’s temper (-2) |
| Persuading | -1 | (4) | |
| Letting patient do what they want | -2 | (4) (5) (2) | |
| Bursting out in anger | -3 | (5) (4) | |
| Confronting patient’s behavior | -3 | (3) (4) (5) |
*To better understand the data, positive and negative values were assigned to each caregiver action.
Analysis
According to my data interpretation, avoiding behavioral triggers and responding compassionately are the most effective actions a caregiver can perform to promote positive interactions among individual's with dementia. Song et al., (2018) define giving a response as "responding in a supportive manner and acknowledging what [the individual with dementia] saw or heard: going along with a patient’s apparent reality and providing reassurance" (p. 23).
Consequently, caregivers that responded in a negative manner, such as bursting out in anger or confronting the problematic behavior, evoked negative responses in their family members with dementia. Negative coping methods were most common when caregivers lacked understanding, knowledge, and the necessary skills to address their loved one's unmet needs.
Conclusion
Developing positive attitudes and strategies for behavior management is key for promoting healthy interpersonal relationships and positive behavioral changes among individuals with dementia. Song et al. (2018) cite the impact of journaling to help caregivers record and identify each individual's unique BPSD triggers. Helpful strategies for managing BPSD include "involving the patient in physical activities, satisfying physiological need states, and diverting the patient’s attention toothers by providing substitutes" (p. 27).
At times, caregiving can feel like a thankless, 24-hour job: caregiver burnout is common, as caregivers report feelings of exhaustion, helplessness, sadness, and overwhelm. And as a spouse or child, caretaking presents additional challenges while navigating new power dynamics within lifelong relationships. Thus, it is of the utmost importance that caregivers maintain their own mental and physical health to better facilitate compassionate interactions with their loved ones.
Resources
Song, J.A., Park, M., Park, J., Cheon, H.J., & Lee, M. (2018). Patient and caregiver interplay in behavioral and psychological symptoms of dementia: Family caregiver’s experience. Clinical Nursing Research, 27(1), pp. 12-34. https://doi.org/10.1177/1054773816678979
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