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Behavioural and psychological symptoms in dementia and the challenges for family carers: systematic review
Feast A, Orrell M, Charlesworth G, Melunsky N, Poland F, Moniz-Cook E.. The British journal of psychiatry : the journal of mental science, 2016-03-17
Topic: Risk, prevention and care in population studies
Background Tailored psychosocial interventions can help families to manage behavioural and psychological symptoms in dementia (BPSD), but carer responses to their relative's behaviours contribute to the success of support programmes. Aims To understand why some family carers have difficulty in dealing with BPSD, in order to improve the quality of personalised care that is offered. Method A systematic review and meta-ethnographic synthesis was conducted of high-quality quantitative and qualitative studies between 1980 and 2012. Results We identified 25 high-quality studies and two main reasons for behaviours being reported as challenging by family carers: changes in communication and relationships, resulting in 'feeling bereft'; and perceptions of transgressions against social norms associated with 'misunderstandings about behaviour' in the relative with dementia. The underlying belief that their relative had lost, or would inevitably lose, their identity to dementia was a fundamental reason why family carers experienced behaviour as challenging. Conclusions Family carers' perceptions of BPSD as challenging are associated with a sense of a declining relationship, transgressions against social norms and underlying beliefs that people with dementia inevitably lose their 'personhood'. Interventions for the management of challenging behaviour in family settings should acknowledge unmet psychological need in family carers.
Key findings
- Results We identified 25 high-quality studies and two main reasons for behaviours being reported as challenging by family carers: changes in communication and relationships, resulting in 'feeling bereft'; and perceptions of transgressions against social norms associated with 'misunderstandings about behaviour' in the relative with dementia.
- Conclusions Family carers' perceptions of BPSD as challenging are associated with a sense of a declining relationship, transgressions against social norms and underlying beliefs that people with dementia inevitably lose their 'personhood'.
Why it matters
This systematic review of 25 studies found that family carers' perceptions of behavioural and psychological symptoms as challenging were linked to a sense of declining relationship, transgressions against social norms, and beliefs that people with dementia inevitably lose their personhood. It suggests interventions should acknowledge these underlying beliefs.
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Study details
- Study designsystematic review
- Evidence strengthHigh
How this study scored 66/100
Published in a peer-reviewed journal, and it is a systematic review of all the studies on the question. Scored zero for sample size, effect reported and studied in people because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (The British journal of psychiatry : the journal of mental science) |
| Journal's citation record | 3 / 4 | The British Journal of Psychiatry: journal h-index 376 (OpenAlex, 2026-10-29) |
| Study design | 12 / 12 | A systematic review of all the studies on the question |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2016 — within 20 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | 5 / 7 | Cited 244 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 20.3 citations a year over 12 year(s) since 2016 |
| Impact for its field and year | 3 / 6 | Cited 3.3× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 8 other studies in this library |
| Still being cited | 3 / 4 | Cited 71 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Esme D. Moniz-Cook: h-index 50 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University College London: institution h-index 2,029 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 7 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 26989095) |
| Free to read | 2 / 2 | Free to read |
| Total | 66 / 100 | — |
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Read the original
- DOI: 10.1192/bjp.bp.114.153684
- PubMed: 26989095
- Original source →
- Free full text: The British Journal of Psychiatry →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Feast, A., Orrell, M., Charlesworth, G., Melunsky, N., Poland, F., & Moniz-Cook, E. (2016). Behavioural and psychological symptoms in dementia and the challenges for family carers: systematic review. The British journal of psychiatry : the journal of mental science. https://doi.org/10.1192/bjp.bp.114.153684
Vancouver
Feast A, Orrell M, Charlesworth G, Melunsky N, Poland F, Moniz-Cook E. Behavioural and psychological symptoms in dementia and the challenges for family carers: systematic review. The British journal of psychiatry : the journal of mental science. 2016. doi:10.1192/bjp.bp.114.153684. PMID: 26989095.
BibTeX
@article{feast2016-26989095,
author = {Feast, A. and Orrell, M. and Charlesworth, G. and Melunsky, N. and Poland, F. and Moniz-Cook, E.},
title = {{Behavioural and psychological symptoms in dementia and the challenges for family carers: systematic review}},
journal = {The British journal of psychiatry : the journal of mental science},
year = {2016},
doi = {10.1192/bjp.bp.114.153684},
pmid = {26989095},
url = {https://doi.org/10.1192/bjp.bp.114.153684}
}
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