Hinchliffe, Ann Catherine; (2002) Management of the behavioural symptoms of dementia and the effect on carers. Doctoral thesis (M.D), UCL (University College London).

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Abstract

Behavioural disturbance commonly complicates dementia and is associated with carer's psychiatric morbidity. This study hypothesised that behaviours specified by carers as distressing could be managed using individually designed care packages which could reduce such behaviours and improve carer mental health as compared to usual care. People with dementia (PWD) and their carers were recruited. Carers were assessed using the General Health Questionnaire and the Geriatric Mental State (GMS) if over 65, or the Clinical Interview Schedule (from which a DSM IIIR diagnosis was made) if under 65. PWD were assessed using the Mini Mental State Examination and the GMS. The Present Behavioural Examination was completed with each carer, who specified which behaviour(s) they found most distressing. Care Packages for each couple were generated by a Multidisciplinary Team (Psychiatrists, Psychologists, Community Psychiatric Nurse, Occupational Therapist, Social Worker, Pharmacist). Couples were divided into two groups: A and B. Group A care packages were implemented over sixteen weeks. Group B acted as controls. Then both groups were reassessed (reassessment 1) using the initial rating scales. Over the following sixteen weeks Group B Care Packages were implemented. Both groups were then reassessed again (reassessment 2). At reassessment 1, compared to Group B, the behaviour of Group A dementia sufferers improved significantly (p<0.001) as did the mental health of their carers (p<0.001). At reassessment 2, the behaviour of Group A dementia sufferers and the mental health of their carers remained improved. These variables were associated. The intervention received by Group B couples neither improved carer mental health nor dementia sufferer behaviour. In conclusion, behavioural complications of dementia can be reduced and this is associated with an improvement in carer mental health. Since no single intervention was significantly effective, it is likely that care packages succeeded because they were tailored to needs.

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