PMID- 33927656
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210502
IS  - 1664-0640 (Print)
IS  - 1664-0640 (Electronic)
IS  - 1664-0640 (Linking)
VI  - 12
DP  - 2021
TI  - Evaluating the Clinical Impact of National Dementia Behaviour Support Programs on 
      Neuropsychiatric Outcomes in Australia.
PG  - 652254
LID - 10.3389/fpsyt.2021.652254 [doi]
LID - 652254
AB  - Background/Objective: People living with dementia (PLWD) in residential aged care 
      homes (RACHs) are frequently prescribed psychotropic medications due to the high 
      prevalence of neuropsychiatric symptoms, also known as behaviours and 
      psychological symptoms of dementia (BPSD). However, the gold standard to support 
      BPSD is using psychosocial/non-pharmacological therapies. This study aims to 
      describe and evaluate services and neuropsychiatric outcomes associated with the 
      provision of psychosocial person-centred care interventions delivered by national 
      multidisciplinary dementia-specific behaviour support programs. Methods: A 2-year 
      retrospective pre-post study with a single-arm analysis was conducted on BPSD 
      referrals received from Australian RACHs to the two Dementia Support Australia 
      (DSA) programs, the Dementia Behaviour Management Advisory Service (DBMAS) and 
      the Severe Behaviour Response Teams (SBRT). Neuropsychiatric outcomes were 
      measured using the Neuropsychiatric Inventory (NPI) total scores and total 
      distress scores. The questionnaire version "NPI-Q" was administered for DBMAS 
      referrals whereas the nursing home version "NPI-NH" was administered for SBRT 
      referrals. Linear mixed effects models were used for analysis, with time, 
      baseline score, age, sex, and case length as predictors. Clinical significance 
      was measured using Cohen's effect size (d; >/=0.3), the mean change score (MCS; 3 
      points for the NPI-Q and 4 points for the NPI-NH) and the mean percent change 
      (MPC; >/=30%) in NPI parameters. Results: A total of 5,914 referrals (55.9% female, 
      age 82.3 +/- 8.6 y) from 1,996 RACHs were eligible for analysis. The most common 
      types of dementia were Alzheimer's disease (37.4%) and vascular dementia (11.7%). 
      The average case length in DSA programs was 57.2 +/- 26.3 days. The NPI scores were 
      significantly reduced as a result of DSA programs, independent of covariates. 
      There were significant reductions in total NPI scores as a result of the DBMAS 
      (61.4%) and SBRT (74.3%) programs. For NPI distress scores, there were 66.5% and 
      69.1% reductions from baseline for the DBMAS and SBRT programs, respectively. All 
      metrics (d, MCS, MPC) were above the threshold set for determining a clinically 
      significant effect. Conclusions: Multimodal psychosocial interventions delivered 
      by DSA programs are clinically effective as demonstrated by positive referral 
      outcomes, such as improved BPSD and related caregiver distress.
CI  - Copyright (c) 2021 Macfarlane, Atee, Morris, Whiting, Healy, Alford and Cunningham.
FAU - Macfarlane, Stephen
AU  - Macfarlane S
AD  - The Dementia Centre, HammondCare, St Leonards, NSW, Australia.
AD  - Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, 
      VIC, Australia.
FAU - Atee, Mustafa
AU  - Atee M
AD  - The Dementia Centre, HammondCare, Wembley, WA, Australia.
AD  - Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, 
      WA, Australia.
FAU - Morris, Thomas
AU  - Morris T
AD  - The Dementia Centre, HammondCare, St Leonards, NSW, Australia.
FAU - Whiting, Daniel
AU  - Whiting D
AD  - The Dementia Centre, HammondCare, St Leonards, NSW, Australia.
FAU - Healy, Madeleine
AU  - Healy M
AD  - The Dementia Centre, HammondCare, St Leonards, NSW, Australia.
AD  - Monash Health, Clayton, VIC, Australia.
FAU - Alford, Marie
AU  - Alford M
AD  - The Dementia Centre, HammondCare, St Leonards, NSW, Australia.
FAU - Cunningham, Colm
AU  - Cunningham C
AD  - The Dementia Centre, HammondCare, St Leonards, NSW, Australia.
AD  - School of Public Health and Community Medicine, University of New South Wales, 
      Sydney, NSW, Australia.
LA  - eng
PT  - Journal Article
DEP - 20210413
PL  - Switzerland
TA  - Front Psychiatry
JT  - Frontiers in psychiatry
JID - 101545006
PMC - PMC8076549
OTO - NOTNLM
OT  - BPSD
OT  - DSA model of care
OT  - caregiver distress
OT  - dementia
OT  - dementia behaviour support programs
OT  - neuropsychiatric symptoms
OT  - person-centred psychosocial interventions
OT  - retrospective pre-post study
COIS- The authors are staff members of The Dementia Centre; a research, education, and 
      consultancy arm of HammondCare, an independent Christian charity which auspices 
      the DSA programs - DBMAS and SBRT. SM is the Head of Clinical Services for The 
      Dementia Centre, HammondCare. MAl is the Head of Business Development, 
      HammondCare. CC is the Director of The Dementia Centre, HammondCare.
EDAT- 2021/05/01 06:00
MHDA- 2021/05/01 06:01
PMCR- 2021/04/13
CRDT- 2021/04/30 06:51
PHST- 2021/01/12 00:00 [received]
PHST- 2021/03/02 00:00 [accepted]
PHST- 2021/04/30 06:51 [entrez]
PHST- 2021/05/01 06:00 [pubmed]
PHST- 2021/05/01 06:01 [medline]
PHST- 2021/04/13 00:00 [pmc-release]
AID - 10.3389/fpsyt.2021.652254 [doi]
PST - epublish
SO  - Front Psychiatry. 2021 Apr 13;12:652254. doi: 10.3389/fpsyt.2021.652254. 
      eCollection 2021.