Systemic approach to behavioural and psychological symptoms of dementia in residential aged care facilities

Residents in aged care facilities are among our most frail and vulnerable citizens. In a humane society, they should be afforded comprehensive, high-quality care that explicitly addresses the known high prevalence of dementia with BPSD. This high-quality individualised care is likely to be predicated upon systematic changes in the RACF environment that go well beyond calls for a reduction in the use of psychotropic medication. Potential proposals for systemic improvement may include: • the provision of services for prompt assessment of residents with mental illness, such as consultation-liaison mental health services, GPs, nurses/appropriately supervised nurse-practitioners, psychologists, pharmacists and allied health professionals visiting RACFs; • GP and specialist collaborative care with nurses/appropriately supervised nurse-practitioners, psychologists, pharmacists and allied health professionals visiting RACFs; • the use of telemedicine and innovative technology approaches in support of the above; • education and up-skilling of care staff to collaboratively implement personalised psychosocial/nonpharmacological interventions (including the health student teaching in RACFs and RACFs as teaching environments); • training in the use of assessment instruments (observation scales/ questionnaires) for common mental health problems by skilled care staff; • changes in the design and organisational culture of RACFs towards improving the mental well-being of residents; • the investigation and development of sustainable funding models for provision of care (Hilmer and Gnjidic, 2013) to allow improved remuneration for RACF personnel, including nursing staff and GPs; • coordination of all of the above, preferably via strong links between primary care and specialist services. Comprehensive systemic review and reform of the provision of mental health care for BPSD within RACFs is needed to address the problem of potential overuse of psychotropic medication.