Evidence-informed non-drug approaches to behavioural and psychological symptoms of dementia in care homes.
This article provides general education for care providers. It does not replace assessment by the resident’s GP, community services, safeguarding team, mental capacity decision-maker, prescriber or emergency services where required. Resident-identifiable information should not be shared through website enquiries.
BPSD is a label, not a care plan
Behavioural and psychological symptoms of dementia can include agitation, aggression, anxiety, depression, hallucinations, delusional beliefs, sleep disturbance, disinhibition, apathy and withdrawal. The label may be clinically useful, but it does not explain what is happening for the individual resident.
Why “try distraction” is not enough
Distraction can help in some situations, but only when it fits the person and the moment. If someone is frightened, in pain or trying to meet a perceived obligation, a random activity may feel dismissive and increase distress.
Useful areas to review
- Pain, constipation, infection, dehydration, hunger and sleep
- Recent change that may suggest delirium or physical illness
- Noise, lighting, crowding, heat and overstimulation
- Care routines, especially personal care and medication rounds
- Communication style, pace and staff consistency
- Meaningful occupation linked to identity and life history
- Family knowledge of preferences, triggers and routines
Build targeted interventions
Non-pharmacological approaches work best when they are linked to a formulation. “Offer activity” is vague. “Offer a quiet folding task after lunch because she becomes anxious when the dining room is busy and she previously took pride in domestic roles” is much more useful.
Mini case example
A resident called out repeatedly in the lounge. Staff initially used reassurance, but the pattern continued. Review suggested poor hearing, difficulty seeing who was nearby, and anxiety when left without a known task. A plan was developed around hearing aid checks, seating position, short predictable contact and a familiar sorting activity. The response targeted likely drivers rather than the calling out alone.
Where medication fits
Medication may be considered in some circumstances, particularly where there is severe distress or risk of harm. It should not replace assessment, formulation, environmental review, psychosocial support or regular review of benefit and harm.
Sources and UK guidance basis
- NICE NG97, including personalised activities, pain assessment, psychosocial and environmental interventions.
- NICE QS184, distress in dementia and understanding causes before treatment.
- CQC guidance on appropriate use of psychotropic medicines in adult social care.
What this article cannot do
General articles can help teams think more clearly, but repeated incidents, safeguarding concerns, placement instability, complex family dynamics, prescribing questions or restrictive practice need case-specific review by the appropriate accountable professionals.
First Response Dementia Services provides focused dementia behaviour review, formulation and practical care planning support for care providers. The aim is to help teams understand the pattern, strengthen documentation and agree realistic next steps.