Non-Pharmacological Interventions for Dementia Behaviours in Care Homes

This study aims to highlight the use of NPIs in order to work with individuals who are experiencing BPSD on a day-to-day basis especially in the care homes setting. The study implements an in-depth ethnographic case study and interviews with care home staffs to analyse the effectiveness of NPIs. The study shows that the residents who might benefit the most from NPIs and from the given that activities were generally those who have an elevated mental capacity and functioning.

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Introduction
People who suffer from dementia and living in the care homes often experience
distressing behavioural episodes in addition to psychological symptoms of dementia (BPSD).
The symptoms of this condition is perceived through the occurrences of aggression, agitation,
along with signs of anxiety and sexual disinhibition accompanied by walking about and
questioning repeatedly (Koder, Hunt & Davison, 2014). These patients are often prescribed
with antipsychotic medications. This antipsychotic medication is often given to these patients
suffering from BPSD as the first line of treatment. However, most of these medications are
associated with some limited efficacy. Therefore, this had led to the development and
application of various non- pharmacological interventions (NPIs) which in turn includes
certain therapies like aromatherapy, multisensory stimulation, massage accompanied by
animal therapy and music therapy. The National Institute for Health Care and Excellence
(NICE) have suggested such therapies (Brechin, 2013). This study aims to highlight the use
of NPIs in order to work with individuals who are experiencing BPSD on a day-to-day basis
especially in the care homes setting. Additionally the paper illustrates the influence of care
practises on the organizational factors that manages the care home environment.
Methodology and design
The study will implement an in-depth ethnographic case study that will be conducted
in total four care homes. This ethnographic case study will include conduction of interviews
with the respondents who will be 40 of the care home staffs. Additionally 384 hours of
participant observations will be considered for the conduction of the ethnographic case study.
There will be a number of 37 interviews approximately with the care home staffs along with
the administration mapping of the psychotropic medications which were prescribed for some
of the residents of the care home. The results will be obtained using the previous postal

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survey conducted with the managers of the care homes. They were able to select the homes
that were suitable to target the purposive sampling used for the case studies. For this study
the responses who were eligible for responses who will be sorted as well as analysed. The
homes will be selected as the potential sites for response that will be perceived to be more
caring for the people experiencing BPSD. Priority will be given to the homes that provide
guide to contact for participation. An increase in the likelihood of gaining relevant findings
was the reason for guidance (Backhouse et al., 2016).
Recruitment will be conducted through the provision of a cover letter along with a
follow up phone call prior to the arranging of the interview. A total of 10 managers of the
care homes will be contacted from a about 80 eligible care homes. Out of these the total
number who will agree to the meeting will be considered at different times over a 5- to 6-
week period and several number of interviews will be conducted with them. Data will not be
written down or will not include the residents or the staff non-participants. A verbal
information about the conducted of the study will be provided to the participants. There will
be a requirement of consent from all of these participants to take part in the study.
In order to conduct data analysis, the data obtained will be typed and will be
anonymised and stored securely. For extensive qualitative data set analysis, the framework
approach will be used. This type of transparent approach will have five phases involving
familiarisation that involves the immersion in the data in order to recognise the key themes.
The other phases are identified a thematic framework that involves assembling of the ideas
from the identified research questions along with the stage of familiarisation made into a
framework and finally indexing that will involve the thematic framework.

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Literature review
The background of the study concerns the use of antipsychotic medications has been
used to manage behavioural and psychological symptoms of dementia (BPSD) all these
years. However, studies have shown that there are certain potential risks associated with the
use of these antipsychotic medications for the individuals who are suffering from dementia,
therefore in such cases it is better to use the non-pharmacological interventions (NPIs), which
according to several studies have been proved as safe alternatives to these antipsychotic
medications (Livingston et al., 2014). However, it is still not clear that how these
interventions can be applied in the setting of the care homes to help the individuals who are
suffering from BPSD. The application of the interventions is still unclear since there is a lack
of literature regarding this topic (Brechin, 2013). The literature that is present is weak in
nature as it mainly comprises of overviews of systematic reviews and systematic reviews.
These mainly assesses whether NPIs are effective for BPSD which in turn is limited due to
the poor quality of the existing studies along with the inconsistency that is present across
studies in addition to consideration of small sample sizes, or the availability of very little
evidence (Ma et al., 2014).
Findings
The analysis of the data will be aimed at breaking down the data collection into each
of the case study. Different aspects will be generated from the given framework. Themes will
be identified using this framework. This particular article will be able to show relation
between the findings and the strategies and behaviours of the theme. The observed data will
be able to show the activities that will be used in several ways. The activities can be observed
such as the watching of television, reading of newspapers and solving jigsaws that usually
occurred without staff contact. The activities such as the massage, aromatherapy along with
reflexology, or nail varnishing and helping staff with jobs and doll therapy will be occurring

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with individuals however there was no necessity whose residents will be needing the
behaviours that they are experiencing . The activities that involving those like the exercises,
or reminiscence along with cognitive stimulation, music therapy in addition to arts and crafts,
entertainment and church services might be provided as the group activities. There are certain
activities like walking outside accompanied with gardening or cooking might also be
provided as either group or individual activities. The barriers that might be included in the
residents of the activities which could be either staff- or resident-led. Some staff members
who avoided the inclusion of residents who were suffering with severe physical or mental
difficulties or those experiencing BPSD in activities. Therefore, the residents who were
experiencing BPSD, and for whom NPIs are recommended as first-line treatments and those
with greater physical impairment or mental impairment, could perhaps have less access to
these activities than residents with higher capacity and functioning. Finally the finally will be
able to show that the care-home staff are taking steps to work hard to engage the residents
successfully in order to improve their well-being (Koder, Hunt & Davison, 2014).
Conduction of individual interventions could be used as the first line of treatments for these
BPSD patients through the implementation of aromatherapy, music therapy or massage. The
activities, which were recommended to be the first-line of treatment by NICE like the
individually tailored aromatherapy long with massage or animal-assisted therapy and
multisensory stimulation and music or dancing, might not appear to be identified by staff as
the major activities especially for use with those residents of the care home experiencing
BPSD (Ma et al., 2014). The researcher (TB) who will be conducting the data collection for
this study should be having several years of paid care work who have experience working
with older people. This experience will help the researchers to cope up with the emotional
aspects of the work. This help to enable development of good rapport and trust which needs

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to be built between the researcher and participants that will help in enhancing the quality of
the data (Backhouse et al., 2016).
Conclusion
From the above discussion, it can be concluded that the work that takes place in the
care homes needs improvement for elevating the general well-being of the residents if the
nursing care homes. This in turn is potentially prevalent for those individuals who are
suffering from BPSD. However, there is an existence of a gap between rhetoric and practice
in this case that needs to be addressed through the implementation of the activities with are
customised interventions especially for the residents suffering from BPSD. Furthermore, the
study shows that the residents who might benefit the most from NPIs and from the given that
activities were generally those who have an elevated mental capacity and functioning.
Finally, there is a need of an action to be taken that will help to aid the incorporation of NPIs
into the care that is usually practiced so that they can be used in the moment that is specific
with these individuals such as the behaviours to occur.

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References
Backhouse, T., Killett, A., Penhale, B., & Gray, R. (2016). The use of non-pharmacological
interventions for dementia behaviours in care homes: findings from four in-depth,
ethnographic case studies. Age and ageing, 45(6), 856-863.
Brechin, D. (2013). Alternatives to antipsychotic medication: psychological approaches in
managing psychological and behavioural distress in people with dementia. British
Psychological Society.
Koder, D., Hunt, G. E., & Davison, T. (2014). Staff's views on managing symptoms of
dementia in nursing home residents. Nursing Older People (2014+), 26(10), 31.
Livingston, G., Kelly, L., Lewis-Holmes, E., Baio, G., Morris, S., Patel, N., ... & Cooper, C.
(2014). Non-pharmacological interventions for agitation in dementia: systematic

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review of randomised controlled trials. The British Journal of Psychiatry, 205(6),
436-442.
Ma, H., Huang, Y., Cong, Z., Wang, Y., Jiang, W., Gao, S., & Zhu, G. (2014). The efficacy
and safety of atypical antipsychotics for the treatment of dementia: a meta-analysis of
randomized placebo-controlled trials. Journal of Alzheimer's Disease, 42(3), 915-937.