Editorial: Innovative practice

While much attention has been given to describing behavioural and psychological symptoms in dementia (BPSD) and estimating their frequency, there seems to be far less advice aimed at preventing and reducing the difficulties they cause for people with dementia, family caregivers and care workers. This concentration on categorising – rather than seeking to support – has led activists such as Kate Swaffer (2014) to warn against using terms such as BPSD or challenging behaviour, arguing that their use is not consistent with person centred care. Others (for example, Rahman, 2017) have preferred the term ‘distressed behaviours’ because it places the onus firmly upon others to identify the reasons behind such symptoms and to then find ways in which they might be resolved.

The first two articles in this issue of Innovative Practice can clearly be included in the prevention and support category. In the first, Deborah Koder (2018) summarises the emerging literature on the use of cognitive behaviour therapy for people with dementia, arguing that a diagnosis of dementia should not preclude people from accessing efficacious treatments.

Sleep disturbances in persons with dementia can be addressed through pharmaceutical and/or non-pharmacological approaches. However, the risks associated with taking sleep medication for people with dementia are often bigger than any possible benefits. The second article by Tewary, Cook, Pandya, and McCurry (2018) describes an intervention in which a trained sleep educator taught family caregivers about the impact of aging and dementia on sleep and how non-pharmacological interventions such as increasing light, regular exercise and sleep hygiene strategies can improve sleep in persons with dementia. Caregivers reported that the programme provided them with valuable strategies that they planned to continue to apply.

The final two articles explore end of life care for people with dementia. In the first, Evans, Harrison-Dening, and Read (2018) explore the role of Admiral Nurses in supporting carers of people with dementia who were reaching the end of their lives. Carers found a range of factors to be fundamental in helping them to cope, including reliable and consistent support, professional with skills to enable emotional needs to be aired, support from a wider healthcare team and communication strategies that minimised the behavioural and psychological symptoms in the person with dementia.

The final article, which is by Harrop, Nelson, Rees, Harris, and Noble (2018), describes a partnership between a hospice in Wales and the Alzheimer’s Society to provide a new service to improve palliative and end-of-life care for people with dementia. Education and training were provided to health and social care professionals, volunteers, families and members of the public. It covered topics such as: symptom management; information on dementia; end-of-life care; advance care planning and emotional support. Family carers reported increased confidence and knowledge and gave them a source of emotional support. Taken together, each article highlights important messages about equity in dementia support and the importance of collaborative approaches to the individual problems that may be experienced by people with dementia and family carers.