DESK REVIEWS | 07.02.01.08. About the assessment and management of behavioural and psychological symptoms, what kind of interventions are available to people with dementia or their informal carers?

DESK REVIEW | 07.02.01.08. About the assessment and management of behavioural and psychological symptoms, what kind of interventions are available to people with dementia or their informal carers?

There are no mainstream dementia-specific non-pharmacological interventions for carers or people living with dementia through the public sector. Private services are available, such as cognitive stimulation therapy, respite care, occupational therapy, arts therapy, etc. There are psychosocial activities through the primary health sector and social care sector for older people in general, such as older people’s centres, older people’s gyms, arts and craft groups, etc. Pharmacological treatment exist and are prescribed through GPs or specialists through a special pharmaceutical scheme called ‘high cost’ (or ‘alto custo’, in Portuguese). These are free of charge for service users; however, the process involved with getting this medicine monthly are often complicated and demands image tests (tomography, MRI), blood tests, neuropsychiatric assessment, and clinical assessment. It is common for people to take over one year to be able to get the pharmacological treatment through SUS due to the need to wait for all these documents, which also need to be regularly updated.

Pharmacological interventions available for persons with dementia to address BPSD symptoms are described in the Clinical Practice Guidelines by Indian Psychiatric Society (Shaji et al., 2018). Non-pharmacological interventions for people with dementia are person-centred and often also involve caregiver participation (Shaji et al., 2018). Some of the interventions available to address behavioural and psychological symptoms associated with dementia include music and dance therapy, multisensory stimulation, reminiscence therapy, etc. (Shaji et al., 2018). The availability of these interventions varies across regions.

References:

Shaji, K.S., Sivakumar, P.T., Rao, G.P., Paul, N., (2018). Clinical Practice Guidelines for Management of Dementia. Indian J. Psychiatry 60, S312–S328. https://doi.org/10.4103/0019-5545.224472

Some interventions were done in the context of research experiments. For instance, a senam poco poco (a type of dance) program was implemented among members of a community gymnasium to evaluate the dance program’s effectiveness in memory capacity (Nastiti et al., 2015). However, this program included only people aged 30 to 50 years old. Moreover, a study was conducted on the effects of poco-poco dance on the executive functions of type 2 Diabetes Mellitus patients with Mild Cognitive Impairment which showed that by doing biweekly poco-poco dance for 30 minutes is able to improve the executive functions (Theresa et al., 2019).

Group Cognitive Stimulation Therapy (CST), a form of nonpharmacological treatment which has been shown effective for dementia in different countries, has also been available in Indonesia, albeit in research settings. Most of this research took place in senior home settings (Sanchia & Halim, 2019; Triestuning & Sipollo, 2019; Yuliana, 2017), but it has also been studied in community-dwelling older people in Indonesia (Komalasari, 2014), and the adaptation of this intervention into the Indonesian context generally has shown promising results.

Music therapy has existed in research settings and as part of Alzheimer’s Indonesia service – although this is not a routine activity yet (Alzheimer’s Indonesia, 2019b). There seem to be considerable interest in this type of therapy. Research on music therapy in Indonesia has been conducted to examine the effect not only on cognitive function but also on the benefit for stress-coping mechanisms (Oktaviani, 2018), sleep problems (Mitayani, 2018), and loneliness in dementia (Arlis & Bate’e, 2019).

Other types of interventions could also be found in Indonesia, mostly in research settings. An experimental study using puzzle therapy was conducted among older people with dementia in one of the social service centres for older people in Yogyakarta Special Region, which showed that puzzle therapy was effective in improving the cognitive function of the elderly with dementia (Erwanto & Kurniasih, 2020). Other studies used traditional games as the intervention, such as halma (Andiny et al., 2016) or dakon (Yulianti, 2018).

Although some of the studies do not directly examine the effect on these interventions on behaviour, these interventions promote meaningful activities for the persons with dementia, which helps reducing BPSD. There is a potential for these interventions to exist outside research settings in Indonesia and future research delving into the feasibility is needed.

References:

Alzheimer’s Indonesia. (2019b). Tentang Alzheimer Indonesia.

Andiny, F., Haryanto, J., & Hadisuyatmana, S. (2016). Permainan halma mencegah progresiftas kerusakan kognitif pada lansia demensia. Jurnal Keperawatan, IX(2), 71–75.

Arlis, & Bate’e, W. V. (2019). Pengaruh Terapi Musik Tradisional Cina terhadap Kesepian pada Lansia di Panti Jompo Yayasan Guna Budi Bakti Kelurahan Martubung Kecamatan Medan Labuhan Kota Medan Tahun 2019. Jurnal Keperawatan Priority, 2(2), 1–14. https://media.neliti.com/media/publications/290559-pengaruh-terapi-musik-tradisional-cina-t-d87767cf.pdf

Erwanto, R., & Kurniasih, D. E. (2020). The effectiveness of puzzle therapy on cognitive functions among elderly with dementia at Balai Pelayanan Sosial Tresna Werdha ( BPSTW ) Yogyakarta , Indonesia. Bali Med J, 9(1), 86–90. https://doi.org/10.15562/bmj.v9i1.1628

Komalasari, R. (2014). Domain Fungsi Kognitif Setelah Terapi Stimulasi Kognitif. Jurnal Keperawatan Indonesia, 17(1), 11–17.

Mitayani, T. (2018). Penerapan Terapi Musik pada Asuhan Keperawatan Lansia dengan Gangguan Tidur di BPSTW Unit Budi Luhur Kasongan Bantul. http://eprints.poltekkesjogja.ac.id/1384/

Nastiti, D. A., Khamdiniyati, N., Latisi, M. P., Aprilia, L., & Nessya, I. A. (2015). Pengaruh Senam Poco-Poco Untuk Melawan Dimensia. Psikostudia, 4(1). http://e-journals.unmul.ac.id/index.php/PSIKO/article/view/2268

Oktaviani, P. (2018). Terapi Musik untuk Meningkatkan Kemampuan Coping Stress Pada Penderita Demensia. http://digilib.uinsby.ac.id/28776/1/Prilia Oktaviani_J91214121.pdf

Sanchia, N., & Halim, M. S. (2019). Terapi Stimulasi Kognitif untuk Lansia dengan Mild Cognitive Impairment: Studi Eksperimental di Panti Wreda. Neurona, 36(4), 258–264. http://www.neurona.web.id/paper-detail.do?id=1123

Theresa, R. M., Nasrun, M. W., Soejono, C. H., & Trihandini, I. (2019). The effects of poco-poco dance on the executive functions of type 2 diabetes mellitus patients with mild cognitive impairment achieved through improvements in neuronal functions and plasticity. International Journal of Pharmaceutical Research, 11(2), 595–601. https://doi.org/10.31838/ijpr/2019.11.02.097

Triestuning, E., & Sipollo, B. V. (2019). Cognitive Stimulation Therapy on Elderly with Dementia in Panti Werdha Pandaan, Pasuruan. International Conference of Kerta Cendekia Nursing Academy, 1, 139–144.

Yuliana, W. (2017). Pengaruh Stimulasi Otak terhadap Tingkat Kognitif Lansia di Panti Werdha Bhakti Luhur. Penelitian Kesehatan, 5(1), 1–5.

Yulianti. (2018). Dampak Program Elderly Day Care Service terhadap Kesejahteraan Lansia Studi kasus di Panti Sosial Tresna Werdha Budi Dharma Bekasi.

Management is mostly based on symptom reduction through pharmacological treatment (prescription by doctors). In counties where there are no psychologists to provide counseling services mainly to the caregiver, management is provided by psychiatric nurses or enrolled/nursing officers. The magnitude of the psychosocial interventions by the latter staff may not be sufficient because of lack of expertise as most health care workers are not very well equipped with information on dementia care. Caregivers are advised on the best ways to take care of their loved ones with little or no emphasis on self-care (Musyimi et al., 2019). The heavy reliance on informal care giving and families impacts negatively on the mental wellbeing and quality of life of caregiver especially in Kenya where respite care and caregiver training centers do not exist.

References:

Musyimi, C., Mutunga, E., & Ndetei, D. (2019). Stigma and dementia care in Kenya: Strengthening Responses to Dementia in Developing Countries (STRiDE) Project. In World Alzheimer Report 2019: Attitudes to dementia (pp. 121–122). London, UK: Alzheimer’s Disease International. https://www.alzint.org/u/WorldAlzheimerReport2019.pdf

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