From: UMASS Chan Medical School/UMass Memorial Healthcare Department of Psychiatry (Dr. Richler); The Queens Medical Center, Honolulu, HI, University of Hawaii John A. Burns School of Medicine Department of Psychiatry (Dr. Shimizu); Cambridge Health Alliance Department of Psychiatry (Dr. Huang, Dr. Kester).
Harv Rev Psychiatry. 2023;31(1):22-27. doi: 10.1097/HRP.0000000000000352.
Behavioral and psychological symptoms of dementia (BPSD) occur frequently among people with dementia and are known precipitants for placement in care facilities. Despite the social, financial, and psychological impact on dementia care, education and discussions on BPSD have not been routinely included in advance care planning (ACP). As a result, families can face great challenges in making complex medical decisions when their loved ones are admitted to the geriatric psychiatric inpatient unit with refractory BPSD. We present the case of an 83-year-old gentleman with BPSD to illustrate universal struggles in dementia care experienced by many families, which could have been alleviated by education and discussions around BPSD earlier in the patient's dementia course. A literature search did not yield any articles that mention discussions of BPSD in ACP. The lack of literature referencing BPSD in ACP supports our clinical experiences with the case and highlights the need for improvement in current dementia care. We propose a guideline for providers to facilitate conversations around BPSD as an integral part of ACP, including discussions of four key points related to the progressive nature of dementia, the commonality of BPSD, the lack of FDA-approved treatment for BPSD, and the difficulty in balancing agitation and sedation to allow safe placement. We firmly believe it is important to start discussion on BPSD as part of ACP as early as possible. Early education and discussion will help to facilitate meaningful care decisions as patients and families navigate the challenges associated with this progressive disease.
痴呆的行为和心理症状（BPSD）在痴呆患者中经常发生，是导致他们被安置在护理机构的重要因素。尽管 BPSD 对痴呆护理有社会、经济和心理方面的影响，但教育和讨论并没有被常规纳入预先护理计划（ACP）中。因此，当他们的亲人因难治性 BPSD 而被收入老年精神病住院病房时，家属在做出复杂的医疗决策时可能会面临巨大的挑战。我们介绍了一位 83 岁男性患者 BPSD 的病例，以说明许多家庭在痴呆护理中普遍面临的困难，如果在患者痴呆病程的早期就进行关于 BPSD 的教育和讨论，这些困难本可以得到缓解。文献检索没有发现任何提到在 ACP 中讨论 BPSD 的文章。ACP 中没有文献参考 BPSD，这支持了我们对该病例的临床经验，并强调了当前痴呆护理需要改进。我们提出了一个供提供者使用的指南，以促进围绕 BPSD 的对话，作为 ACP 的一个组成部分，包括讨论与痴呆的进展性质、BPSD 的普遍性、缺乏 FDA 批准的 BPSD 治疗方法以及平衡激动和镇静以允许安全安置相关的四个关键点。我们坚信，尽早将 BPSD 作为 ACP 的一部分进行讨论非常重要。早期教育和讨论将有助于促进有意义的护理决策，因为患者和家属在应对这种进行性疾病的挑战。
