Palliative Care for People With Very Severe to Extreme Behavioural and Psychological Symptoms of Dementia (BPSD): A Scoping Review.
Maree Gallop, Jenny Ford, Alexandra Bowman and 4 others
PMID 40331734WHAT IT FOUND
Agitation in people with very severe BPSD in hospital was often treated with antipsychotics or restraint without checking pain, constipation, infection or delirium.
Look for unmet needs, use behavioural and pain tools, and involve families and palliative care early.
Key findings
01All six included studies found inadequate symptom assessment and management for people with very severe BPSD, leaving pain, delirium and other causes untreated.
02Agitation was often treated with antipsychotics or restraint without a thorough behavioural and pain assessment; one study reported 37% of patients were started on antipsychotics during admission and 71% of these prescriptions were new, most commonly for agitation.
03Families were not adequately consulted, and mood or BPSD assessments were recorded in only 7% of patients, while 79% of palliative care referrals had no collateral history.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The evidence base was small and mixed, with qualitative studies, case reports, audits and one pilot randomised trial. The review focused only on hospital settings, so it does not address home or residential aged care. Definitions of very severe to extreme BPSD were not consistent across studies, so some relevant papers may have been missed. The review mapped literature rather than testing whether palliative care improves outcomes. Searches were limited to English-language published data, and authors did not contact study authors for missing information. Only six studies were included, so findings are descriptive rather than definitive.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read agitation in very severe BPSD as a behaviour to control with antipsychotics or restraints. The review found these treatments were often used without thorough pain and behavioural assessment, and agitation may signal pain, constipation, infection, delirium or other unmet needs.