Dementia Care

13 / 40

Vol 5 No 3 June/July 2016 Australian Journal of Dementia Care 13
What language choices represent the best fit
given the need both for clarity in a clinical context
and the aspiration to support personhood across
all sectors of our communities?
Although a number of different phrases and
words have been the subject of discussion, this
article will focus on the use of the following
phrases and present the case for and against the
use of these terms (see boxes above and next page):
• Behavioural and psychological symptoms of
dementia (and the various alternatives and
options); and
• Managing behaviour/behaviour management.
For a broader description of appropriate
language in various contexts, please refer to the
Alzheimer’s Australia Dementia language guidelines
).
How important is the
context of the communication?
The context in which the communication is taking
place is an important part of the overall picture. To
varying degrees, people contextualise their
language choices across a number of different
continua: the level of formality in the setting, how
familiar the other parties are with the topic, the
BPSD
Managing behaviour
The case for using this term
“Using BPSD leads people to see a person’s response to a situation
as a symptom demanding intervention ie, seeking the underlying
cause/need” (Winbolt M 2015 PowerPoint presentation on BPSD) .
People expressing their needs or preferences in strongly assertive
or ‘unusual’ ways may be labelled as manipulative or deliberately
disruptive. The term BPSD focuses on dementia to avoid the person
being blamed.
Descriptions of BPSD help clinicians to differentiate BPSD from
similar mental health symptoms. (See Letter to Editor by Paul
Williams in Australian Journal of Dementia Care Feb/March 2016
5(1) p5).
The case against
“Not using BPSD leads people to see a person’s response to a
situation as a ‘normal human response’ demanding intervention:
seeking the underlying cause/need” (Winbolt M 2015, PowerPoint
presentation on BPSD).
A person’s expressions of distress may be dismissed by staff as
being caused by dementia, thereby negating action and personal
responsibility – “it’s the dementia, there is nothing we can do”.
The term may reduce the possibility for insight into family and care
professional behaviours and routines which may be a contributing
factor to the person’s behavioural expression/distress.
“The term BPSD can be problematic in that it can be construed that
somehow these problems are inevitable or inexplicable” (Brooker D
2011, cited in Australian Journal of Dementia Care Oct/Nov 2012
1(3) p36).
The term BPSD is part of a bio-medical model and pathologising of
behaviour and emotion. If you have a diagnosis of dementia, all of
your actions and expressions are viewed through a
‘dementia/disease lens’ (Dupuis et al 2012). This does not support
a person-centred approach.
The case for using this term
‘Managing the behaviour’ means managing the underlying
contributing factors of the behaviour. The term is a shorthand way
of saying that we need to manage the circumstances and
interactions under which the behaviour may occur.
‘Managing’ also refers to a number of processes which may be
happening simultaneously within a bio-psycho-social approach
including assessing, charting, educating staff, mediating between
family members/staff, trialling interventions and so on.
The case against
The word ‘managing’ contains an implicit power imbalance between
the person with the behaviour in question (who is presumed to be
in need of managing) and the person (who does not have a cognitive
impairment) doing the managing.
‘Managing behaviour’ may be misinterpreted as managing the
symptoms (as opposed to the contributing factors). Some critics
have suggested that ‘managing/BPSD’ puts the emphasis on the
symptoms and that this can lead to inappropriately prescribed anti-
psychotics or benzodiazepines.
‘Managing’ has a similar connotation to ‘dealing with (a behaviour)’
or ‘handling’– which again implies that control needs to be exerted
over another person.
The term ‘manage/managing’ sounds negative and impersonal. It
doesn’t proactively convey a sense of hope that our sights can be
set beyond managing behaviour to reach for enabling well-being.
Both the terms BPSD and ‘managing behaviour’ may lead to an
uncritical acceptance of the need to manage/control/minimise the
symptoms instead of searching for the cause of the symptoms.