“A gilded cage is still a cage” – BPSD and DoLS

I’m delivering dementia training currently, and this blog will include links that might be useful to those in primary care and/or care homes. Two areas I’ve been asked to cover are BPSD (behavioural and psychological symptoms of dementia) and the Mental Capacity Act/ DoLS (Deprivation of Liberty Safeguards).


Jargon I’m afraid but this acronym has entered common usage.  The Faculty of Old Age Psychiatry’s guidance (Faculty of the Psychiatry of Old Age Atypical antipsychotics and BPSD Prescribing update for Old Age Psychiatrists) produced some years ago is still on the net and I think it still says some sensible things (but we need to remember that risperidone has a licence for short-term treatment -up to 6 weeks- of persistent aggression in people with moderate-severe Alzheimer’s disease unresponsive to non-drug treatments and where there is a risk of harm to self/others). Having said that, non-drug approaches should always be the first choice.

I find it useful to think about using an ABC chart in care homes to document what is happening – if nothing else it gives a baseline to measure against. There are lots of versions online (or you can make your own). Here is a link to one. I’ve seen people use the Cohen Mansfield Agitation Inventory NH version, but my worry is that so much energy may go into charting what is happening that the person (and understanding them) may get lost. Pain scales are sometimes useful in assessing people with dementia – here is a link to the Abbey pain scale but there are others.

Thinking about BPSD and its management, the Alzheimer’s Society has several useful factsheets/ leaflets for carers and for professionals. I particularly like Changes in Behaviour for carers; Drugs used to relieve behavioural and psychological symptoms in dementia; and Non-pharmacological therapies for the treatment of behavioural symptoms in people with dementia.

Mental Capacity Act/ Deprivation of Liberty Safeguards (DoLS)

Here is a link to the Mental Capacity Act Code of Practice.

DoLS (another acronym) is attracting much head-scratching at the moment (and is one of the areas where pathologists and old age psychiatrists share an interest – is it reasonable to refer everyone who dies whilst subject to a DoL to the coroner for investigation?) Perhaps I need to declare another interest here, I am a member of the Alzheimer’s Society, but one reason for that is that I think the Society produces some good quality information. One of their useful Factsheets is Deprivation of Liberty Safeguards (DoLS). The Law Commission consultation on DoLS can be found here, and it is probably useful to look at the Supreme Court Judgement that has brought matters to a head – you can find it here. It has launched the memorable quotation (courtesy of Lady Hale) “a gilded cage is still a cage”.

In the interest of brevity I’ve missed out quite a lot of other useful links but if anyone wants to add any more links on either of these topics, please feel free to do so.

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