Background Australia's population is aging. Between now and 2025, the number of older people (65 to 84 years) is expected to double and very old people (85 and over) is expected to quadruple.
The projected population growth of older people poses significant challenges such as increased prevalence of dementia which needs careful planning to ensure experienced staff and adequate resources are allocated to care for these patients.
All most all patients with dementia experience BPSD at some stage of their illness. With increasing dementia prevalence, prevalence of BPSD is also expected to increase. This trend is already seen in clinical practice.
Severely agitated, aggressive patients pose significant threat to themselves, other patients and staff with resultant occupational violence, staff burn out, challenges in staff recruitment and retention. Further, no clear consensus for managing BPSD is currently available.
Our outer metropolitan medium size hospital has a 24 bedded acute Geriatric unit catering for a mixed population of Geriatric patients presenting with acute delirium, severe BPSD and GEMS. They are co-managed in a conventional acute hospital ward where medical outliers are also accommodated.
Absence of outdoor access, limited diversional therapy activities, staffing constraints, difficulties in accessing older person mental health services, limited clinical research evidence for non- pharmacological and pharmacological management strategies, significant incidence of occupational violence are few of the challenges we face every day.
We would like to share our experience over last few years, some solutions we found and suggestions to improve the care of this cohort of patients.
Change Use of Pittsburgh agitation scale, 4AT and bowel check on every patient admitted with BPSD, clear nursing documentations related to BPSD, discussion of each case in daily morning Multidisciplinary Team meeting, 1:1 and 1:4 cohort specialling by Assistants in Nursing with special interest in Geriatrics, individual and group diversional therapy activities, use of regular and as required anti-psychotics with monitoring using Pittsburgh agitation scale, staff training on BPSD and occupational violence, requesting security staff assistance early, reporting occupational violence and security staff interventions and use of multiple pharmacological agents early are the changes to routine practice.
Learnings Using concurrent non-pharmacological and pharmacological management strategies from the admission, obtaining trauma and mental health history, training nursing staff to identify escalating behaviours and to use the pharmacological and security interventions when required, utilizing multiple pharmacological agents longer-term with monitoring for the side effects are strategies identified to manage BPSD effectively.