Time to invest in nonpharmacological interventions for behaviours and psychological symptoms associated with dementia

Background Behaviours and psychological symptoms associated with dementia (BPSD) affect up to 90% of people living with dementia and strongly correlate with functional and cognitive impairment (Cerejeira et al. 2012). BPSD cause high levels of distress for people living with dementia, families, carer partners and staff, and impose significant service‐related and other costs. Nonpharmacological person‐centred interventions can reduce agitation and other BPSD though uptake is limited. This is possibly due to concerns about cost and staff time, driven by insufficient awareness of studies that have focused specifically on economic analysis and demonstrated potential savings that can be made. We aimed to evaluate the cost‐effectiveness of non‐pharmacological interventions to reduce BPSD. Method We reviewed studies that calculated overall cost of BPSD symptoms, costs of individual BPSD (e.g. agitation), and costs of nonpharmacological interventions for reducing BPSD (i.e. cost per unit reduction on the Neuro‐Psychiatric Inventory (NPI) or Cohen‐Mansfield Agitation Inventory (CMAI)). Papers included cross‐sectional, prospective and longitudinal studies, intervention studies and one systematic review. Result Approximately 30% of total annual cost of a community‐dwelling person living with dementia is invested in the direct management of BPSD (Beeri et al. 2002). Agitation was reported to increase dementia costs by 17% per month in family care costs in a community home care setting (Costa et al. 2018) and 44% in total annual costs in a residential care home setting (Sköldunger et al. 2019). Linear regression approaches show several nonpharmacological interventions were effective in reducing agitation where the incremental cost per unit reduction in CMAI score ranged from £3 to £62 for person‐centred care training, £4 for music therapy, £24 to £143 for sensory interventions and £162 to £3480 for activities (Chenoweth et al. 2008; Livingston et al. 2014). Cost‐effectiveness was also demonstrated for physical activity reducing BPSD (D'Amico et al. 2016). Conclusion Potential savings and cost‐effectiveness gains can be made by investing in treatments for BPSD that are symptom‐targeted and person‐centred, providing strong incentives for service providers to adopt such interventions. Effective partnerships between care providers, researchers and government bodies, and targeted investments are required to support the initiation of these changes.