Aim
With BPSD incidence expected to rise in Australia and the availability of cognitive units being limited, the study aims to determine if an acute ward follows best practice guidelines in managing BPSD. This study reviews current management practices for Behavioural and Psychological Symptoms of Dementia (BPSD) in an acute geriatric unit at Ipswich General Hospital.
Methods
Patients admitted between May and November 2024 with BPSD diagnosis were included. Exclusion criteria are behavioural disturbances due to acute mental illness, delirium, and no BPSD diagnosis. Deidentified data were collected from electronic medical records. Analysis was conducted with the assistance of a statistician.
Results
Forty participants (75% male, mean age 79.6 years) were included. Most were significantly frail (mean Clinical Frailty Score 5.88; 72.5% scoring 6) and predominantly had mixed or vascular dementia (40% each). Leading symptoms included wandering (67.5%), verbal aggression (71.8%), and physical aggression (60%). Antipsychotics (87.5%) and antidepressants (72.5%) were frequently used, with 75% receiving ≥2 psychotropic agents. Regular pharmacotherapy reviews occurred for 97.5% of participants. 50% have behavioural management plans documented. Diversional therapies were provided to 80%. Mean Pittsburgh score was 3.98 on admission and 2.53 on discharge. Discharge outcomes included 60% transferred to residential care facilities, 15% readmitted within 30 days, and 17.5% mortality within 30 days.
Conclusion
Managing severe BPSD in a non-specialised setting is challenging due to significant patient frailty and complex needs. Extensive pharmacological and non-pharmacological strategies were implemented. Behavioural improvements were noted, highlighting the need for further comparative studies with specialised units.