title: Behavioural and psychological symptoms of dementia: a seven-tiered model of service delivery.
abstract: People with dementia usually experience behavioural and psychological symptoms of dementia (BPSD) during the course of their illness. Currently, in Australia, there is a lack of comprehensive planning for managing and preventing BPSD, and the resources required for optimal care are inadequate and unevenly distributed. We propose a seven-tiered model of service delivery based on severity and prevalence of BPSD, ranging from no dementia through tiers of increasingly severe behavioural disturbance to the propensity for extreme violence in a small number of individuals. Each tier is associated with a different model of intervention. People with dementia may move up or down between tiers depending on their condition, their care and the intervention provided. Lower-level interventions may prevent the need for the more intensive interventions needed when disturbance becomes more severe.
authors.affiliation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Avoca Street, Randwick, NSW 2031, Australia. h.brodaty@unsw.edu.au
authors.forename: Henry
authors.initials: H
authors.lastname: Brodaty
authors.forename: Brian M
authors.initials: BM
authors.lastname: Draper
authors.forename: Lee-Fay
authors.initials: LF
authors.lastname: Low
mesh_terms: D000368:Aged; D001315:Australia; D003695:Delivery of Health Care; D003704:Dementia / Q000145:classification / Q000523:psychology* / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D008875:Middle Aged; D010347:Patient Care Planning; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index