The use of non-pharmacological interventions for dementia behaviours in care homes: findings from four in-depth, ethnographic case studies.
BACKGROUND
antipsychotic medications have been used to manage behavioural and psychological symptoms of dementia (BPSD). Due to the potential risks associated with these medications for people with dementia, non-pharmacological interventions (NPIs) have been recommended as safer alternatives. However, it is unknown if, or how, these interventions are used in care homes to help people experiencing BPSD.


AIM
to explore the use of NPIs in care homes to manage BPSD.


METHODS
In-depth, ethnographic case studies were conducted in four care homes; in total, they included interviews with 40 care-home staff and 384 hours of participant observations.


FINDINGS
NPIs, some of which are the focus of efficacy research, were used in care homes but predominantly as activities to improve the quality of life of all residents and not identified by staff as meeting individual needs in order to prevent or manage specific behaviours. Socially relevant activities such as offering a cup of tea were used to address behaviours in the moment. Residents with high levels of need experienced barriers to inclusion in the activities.


CONCLUSIONS
there is a gap between rhetoric and practice with most NPIs in care homes used as social activities rather than as targeted interventions. If NPIs are to become viable alternatives to antipsychotic medications in care homes, further work is needed to embed them into usual care practices and routines. Training for care-home staff could also enable residents with high needs to gain better access to suitable activities.
['Backhouse|Tamara|T|', 'Killett|Anne|A|', 'Penhale|Bridget|B|', 'Gray|Richard|R|']
D000203:Activities of Daily Living D000884:Anthropology, Cultural D001291:Attitude of Health Personnel D032763:Behavior Control D003704:Dementia D007722:Health Knowledge, Attitudes, Practice D006282:Health Personnel D006707:Homes for the Aged D006801:Humans D007318:Inservice Training D007407:Interviews as Topic D009735:Nursing Homes D036301:Qualitative Research D011788:Quality of Life D012919:Social Behavior D016896:Treatment Outcome D000078329:Workforce
non-pharmacological intervention dementia care home BPSD activities older people