About this Research Topic

Background

People living with dementia are frequently overprescribed psychotropic medications, such as benzodiazepines and antipsychotics. Almost half of all aged care residents living with dementia are prescribed an antipsychotic, of which up to 90% have been found to be potentially inappropriate. For people experiencing severe behaviors in dementia, this figure could be higher, with vast over-reliance on psychotropic medications for its management. Although a small number of cases of acute or severe behavioral symptoms may require the time-limited use of antipsychotics that have de-prescribing plans in place, much prescribing is ineffective and is associated with high rates of adverse events including falls, increased hospitilization, worsening morbidity, and increased mortality rates.

Current guidelines that address behaviors in dementia recommend non-pharmacological
interventions as first-line treatments. These include applying multimodal person-centered psychosocial interventions that focus on the individual’s unmet needs (such as pain, delirium), and also address cultural or environmental factors. Recent evidence suggests that these interventions are approximately 5-8 times more effective than antipsychotic drug treatments.

Two out of three people with dementia live in the community. Carer burden associated with behaviors and psychological symptoms of dementia is a primary factor for entry into
residential aged care and this may result in the subsequent rise of psychotropic use, including antipsychotics. Availability of extensive and holistic carer supports such as daily respite programs are vital to maintaining carer well-being and quality of life.

The goal of this Research Topic is to present the latest evidence on the impact of behavior support programs and models of care that entail non-pharmacological, person-centered interventions to address behaviors and psychological symptoms of dementia across various stages of the condition and in any care setting. The Research Topic encourages contributions that highlight the value of a diverse range of behavior supports for people living with dementia in residential, acute, community, and palliative care. Topics may include, but are not limited to:
• the design of the built environment
• respite care
• multimodal and/or multidisciplinary models of care
• therapeutic application of innovative technologies (e.g., robotic social care, telecare, music therapy)
• innovative models of care such as intergenerational care.

Contributions describing non-pharmacological strategies with current interventions from a health economic, policy and practice, and lived-experience perspective will also be
encouraged. Furthermore, contributions addressing the adverse effect burden, the limited evidence of efficacy of antipsychotics drugs as a treatment, and the role of deprescribing and medication reviews to prevent harmful medication interaction and adverse events such as falls are encouraged.

We anticipate that this Research Topic will be broadly informative to policymakers, aged care providers, clinicians, psychiatrists, psychologists, health researchers, and health economists. We welcome original research articles, systematic review articles, research methodologies, and policy and practice reviews addressing the above aims.

Keywords: dementia, complex dementia, Alzheimer's behaviors in dementia, models of care design, antipsychotic deprescribing

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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