Last month, The Globe and Mail reported on the Ontario Government’s revamping of the Behavioural Support Systems framework. The program aims to enhance care for patients with Alzheimer’s and other dementias who suffer from aggression and other challenging behaviours related to their neurological condition. This is an important initiative that tackles a very common, but often neglected problem encountered in patients suffering from dementia.
It is estimated that over half of all patients with dementia will suffer significant changes in behaviour as part of their illness. The medical term for these changes is Behavioural and Psychological Symptoms of Dementia (BPSD). Up to 40% of patients with BPSD will unfortunately suffer from aggression and agitation.
The overarching principle of the government’s Behavioural Support Systems framework is to deliver person and caregiver directed care. The six supporting principles include: 1) the idea that behaviour is a communication by patients, 2) taking into account patient diversity, 3) providing collaborative care, 4) promoting safety, 5) system coordination and integration, and 6) accountability and sustainability.
In April 2011, the government announced that they would be hiring 75 full-time nurses specialized in behavioural management throughout all of Ontario’s Local Health Integration Networks. This is a very positive and much needed step forward.
The government’s plan recognizes that training and education will play a vital role in further developing this framework – and opportunities for such education must be rapidly developed. I couldn’t agree more, and Baycrest could play an important role in assisting the provincial government in this work.
Baycrest is highly regarded for its expertise in treating patients with BPSD. Baycrest’s Behavioural Neurology Unit has over 25 years of experience in this area. This expertise extends to managing outpatients with dementia in its Sam and Ida Ross Memory Clinic. Efforts were initially pioneered by the clinic’s current medical director Dr. Morris Freedman, one of Canada’s leading clinicians in the diagnosis and treatment of some of the most difficult-to-diagnose dementias. Dr. Freedman has made a considerable effort to share his knowledge and experience by training several Behavioural Neurology Fellows over the years, such as myself. Other physicians have since come to join in this important work. In addition, multidisciplinary teams have come together, with the support of Baycrest, for both outpatient and inpatient care.
In the Globe article, I was quoted as saying that the hiring of more healthcare workers for behavioural support, should not be viewed as a panacea. To clarify, it is an important first step by the government. Liberating funds to hire more healthcare workers is essential. Instituting training programs for those workers will be a vital second step. In the long run, much more research is needed on what those training programs should entail, and on the best interventions needed.
Now that this important problem is getting more press, there is hope that progress will continue in this research, in training, and ultimately will result in improved outcomes for patients.
For information on the Ontario Government’s Behavioural Support Systems framework, go to the website: http://www.akeresourcecentre.org/BSS.
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