Kathleen Weissberg: Thank you to everyone for coming. This is my niche area, and one that I am very passionate about.
Background (AHRQ, 2014)
An estimated five million Americans right now suffer from dementia, and about 14% of those age 70 or older actually have dementia. We have more than 15 million people providing caregiving to the individuals who have dementia. When you look at the cost of that caregiving, we are looking at both formal care that we provide perhaps in a facility or informal care that we are providing at home. Statistics, from 2010, show that we are spending $215 billion in caregiving alone, and it is the most costly thing in dementia care. The reality is that the cost goes up 30% more when an individual has behaviors.
Behavioral and Psychological Symptoms of Dementia (BPSD)
We are now going to talk about the behavioral and psychological symptoms of dementia. BPSD is an umbrella term to talk about the symptoms of disturbed perception, thought content, mood, or behavior that frequently occur in patients with dementia. This is the actual definition from the International Psychogeriatric Association. When you look at folks in long-term care, specifically with dementia, we see that we have upwards of 78% with dementia. Of those with dementia, 76% of them have behavioral and psychological symptoms of dementia. Symptoms include: wandering, pacing, disrobing, overdressing, and all those different types of things. Unfortunately, we end up labeling them as agitated, aggressive, or disruptive, none of which are attractive labels for these individuals (AHRQ, 2014).
Distress to Caregivers
Obviously these behaviors cause a great amount of distress to caregivers, both informal and formal. It is a large part of why individuals are brought to long-term care or to institutions. Even in our facilities, we see that caregivers are inclined to either abuse the client or turn to antipsychotic medications to deal with those behaviors. I have seen scenarios where individuals are left to sit in their urine because they are asking repeatedly to go to the bathroom or something like that. That is a form of abuse, and we do still unfortunately see those things happening.
Theoretical Frameworks
There are four theoretical frameworks that we can look at that help to explain the etiology of behavioral disorders. The first is the biologic/genetic. This says that dementia causes changes in the brain, that in turn result in these problematic behaviors. We also see a behavioral framework which indicates that there is a relationship, if you will, between the client and his or her environment. Something in the environment causes this person to have these behaviors or to act out the way that they are. We will also talk about reduced stress threshold frameworks. These say the person is unable to reduce their stress that they have because of environmental stimuli, maybe sounds or light in the environment, or something else that is happening. They cannot manage their stress, and we see behaviors. Finally, there are the unmet needs (Cohen-Mansfield, 2013). This is where we will start.
