The Fife Dementia Strategy: 2010 – 2020 - The Knowledge Network

psychoactive medicines have been shown to have for many people with
dementia, including the worsening of symptoms. In addition to guidance on
reviewing medications, there is a development need for care staff and
physicians in regard to using such treatments in people with dementia, and
the important role that psychological interventions can have.
Psychological interventions for people with dementia have been shown to be
effective ways to improve quality of life at earlier and later stages of the
illness 22 . The individualised nature of such approaches has meant that large
randomised controlled trials are generally not appropriate, and thus evidence
of their efficacy is often said to be lacking although anecdotal and small scale
research evidence showing positive benefits is plentiful 23 . Guidelines
recommend that behavioural management approaches be pursued before
considering the prescription of psychotropic medication 24 but this is often not
the case in practice. Psychological interventions to treat behavioural
symptoms of dementia involve detailed analysis of a specific behaviour and
the context in which it occurs. Triggers can then be identified which can be
addressed or altered to reduce or eliminate the behaviour concerned. Such
interventions can reduce distress in the person with dementia themselves as
well as leading to greater understanding and enhanced skills in the carers and
staff who work alongside the clinical psychologist or other appropriately skilled
professional. Whilst interventions with individuals are important, changes to
the regime in a whole care setting to support and facilitate a psychological
approach are likely to lead to greatest benefit. This can include specific
training in behavioural interventions leading to changes in staff attitudes and
behaviour as well as changes to the physical and social environment.
New treatments in development - People who volunteer for clinical trials
may gain access to promising drugs before these compounds are approved
for the marketplace. As has been the case for cancer patients for many years’
patients with dementia should have the possibility to make informed decisions
as to whether or not they would like to participate in ongoing clinical trials. A
facility in which this can happen should be included in the development of the
joined up care management system (See 4.1.3).
B. General Health
As approximately 50% of the population with dementia are over 85 years
there is a need to consider the complex health needs and treatment of this
part of the population, with dementia forming one part of what is known as the
frailty syndrome (see definition of Frailty on page 31)
In order to ensure the medical needs of people with dementia are being met at
all ages and stages of the condition their medical treatments need to be
adapted in keeping with the severity of the frailty syndrome and other general
health needs. In such cases of frailty joint GP and specialist input will be
22 For example see NICE Clinical Guideline 42: Dementia (2007).
23 SIGN 2006.
24 Howard R, Ballard C, O’Brien J et al (2001). Guidelines for the management of agitation in
dementia. International Journal of Geriatric Psychiatry. 16: 714-717.
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