title: The use of non-pharmacological interventions for dementia behaviours in care homes: findings from four in-depth, ethnographic case studies.
abstract: antipsychotic medications have been used to manage behavioural and psychological symptoms of dementia (BPSD). Due to the potential risks associated with these medications for people with dementia, non-pharmacological interventions (NPIs) have been recommended as safer alternatives. However, it is unknown if, or how, these interventions are used in care homes to help people experiencing BPSD.
  
  
  
  to explore the use of NPIs in care homes to manage BPSD.
  
  
  
  In-depth, ethnographic case studies were conducted in four care homes; in total, they included interviews with 40 care-home staff and 384 hours of participant observations.
  
  
  
  NPIs, some of which are the focus of efficacy research, were used in care homes but predominantly as activities to improve the quality of life of all residents and not identified by staff as meeting individual needs in order to prevent or manage specific behaviours. Socially relevant activities such as offering a cup of tea were used to address behaviours in the moment. Residents with high levels of need experienced barriers to inclusion in the activities.
  
  
  
  there is a gap between rhetoric and practice with most NPIs in care homes used as social activities rather than as targeted interventions. If NPIs are to become viable alternatives to antipsychotic medications in care homes, further work is needed to embed them into usual care practices and routines. Training for care-home staff could also enable residents with high needs to gain better access to suitable activities.
authors.affiliation: School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK.
authors.forename: Tamara
authors.initials: T
authors.lastname: Backhouse
authors.affiliation: School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Killett
authors.affiliation: School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK.
authors.forename: Bridget
authors.initials: B
authors.lastname: Penhale
authors.affiliation: Nurse Education and Research Department, Hamad Medical Corporation, Doha, Qatar.|Office Of Nursing And Midwifery, LaTrobe University, Melbourne, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Gray
mesh_terms: D000203:Activities of Daily Living; D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D032763:Behavior Control / Q000379:methods*; D003704:Dementia / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education; D006707:Homes for the Aged; D006801:Humans; D007318:Inservice Training; D007407:Interviews as Topic; D009735:Nursing Homes; D036301:Qualitative Research; D011788:Quality of Life; D012919:Social Behavior; D016896:Treatment Outcome; D000078329:Workforce
keywords: BPSD; activities; care home; dementia; non-pharmacological intervention; older people