A note now on BPSD.

BPSD is an acronym coined to refer to 'behavioural and psychological symptoms in dementia'.

This was a term coined by a drug company, for a conference, to introduce drug treatment of certain symptoms in dementia.

These symptoms definitely exist in advanced dementia.

But I don't feel it's useful to group them by one name.

I am deeply concerned by pathologising behaviour, indeed as much as I am by normalising dementia - the movement of 'living well' have overplayed their hand. This movement inadvertently, unfortunately, includes people who do not have dementia.

Having thought about alternative terms such as 'challenging behaviour' or 'distressed behaviour', I have concluded therefore it is sufficient just to call it something like 'distress'.

The reaction to mum repeatedly asking me getting agitated asking what time the carer will come is not to dose her up with an antipsychotic.

A more appropriate reaction is to appreciate that she will forget what I am telling her, will tend to perseverate, and needs reminding the carer will soon arrive.

Indeed it is counterintuitive to think. the treatment of distress is an injection in the leg.

We must take this seriously, and not deny these symptoms. We know that patients find deeply traumatic any attempts by the medical profession to deny their symptoms.

This is an issue which merits attention particularly now, because of the enhanced scope for inappropriate use of antipsychotics 'behind closed doors' for both symptoms of delirium and 'BPSD' in dementia.

Elder abuse is a significant problem in many jurisdictions. This problem is further exacerbated by lack of transparency, and restricted access of family/friends/relatives/carers to care settings.

I've been appalled to see the outdated term in the @JRCPTB revised curriculum for geriatric medicine to be implemented in 2022, because the field has in fact globally advanced way beyond that.