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The challenge of bridging the gap between assessment and intervention in people with dementia care

The behavioral signs and manifestations of distress in people with dementia and other mental health conditions have been labeled with different terms. The academic and clinical world have been involved in an effort to move away from negative images of the aging process. Thanks to the progressive involvement of people with dementia and their carers in the working groups and research teams, stigmatizing language has been progressively left behind. Lately, there is a consensus (James andMoniz-Cook, 2018) on the use of terms such as “behavioural and psychological symptoms” or “behaviours that challenge” (instead of challenging behaviors). Monfort et al. (2020) propose the term “disconcerting”, focusing on the effect that these behaviors may have in the carer. Understanding and assessing the needs of those affected with these symptoms and their carers is crucial to provide the adequate support. Behavioral symptoms are one of the most problematic to deal with in the care of people with dementia, affecting more than 90% of individuals at some point during the course of the disease (Bergh et al., 2011). They have been associated with decreased quality of life (Karttunen et al., 2011) and increased healthcare costs (Herrmann et al., 2006). Of the various instruments used to assess behavioral disturbances is the Neuropsychiatric Inventory (NPI). It is probably the most widely used, as it has been reported to have excellent validity and reliability and has a Nursing Home version (NPI-NH) (Wood et al., 2000). However, it has been questioned for its clinical utility, interrater reliability, factor structure, responsiveness, and long administration time (Lai, 2014). In this volume, Monfort et al. (2020) present their validation of the Psychogeriatric Inventory of Disconcerting Symptoms and Syndromes (PGI-DSS), an instrument intended to overcome the limitations associated with the NPI-NH. This inventory is the outcome of a process of 16 years of construction and validation, which started listening to emotionally exhausted professional caregivers and led to 16 items grouped in 4 syndromes (violence, refusals, words, and acts) confirmed by factor analysis. The wording was selected from the professional caregiver verbatim and then translated to the inventory, what makes it familiar and easily understandable for caregivers. This brief (up to 4 minutes administration time) assessment instrument has a peculiarity: its reverse side serves as a guide to target evidence-based psychosocial interventions that address the identified disconcerting syndrome. The use of psychosocial interventions based on the person-centered care model (Fossey et al., 2014) has been reported as an evidence-based alternative for the management of neuropsychiatric symptoms, but their benefit on health-related quality of life is still to be established (Ballard et al., 2017). One of the strengths of the PGI-DSS seems to be that, at the same time that allows to quickly assessing disconcerting symptoms and syndromes, it links the results to concrete paths of action suggesting evidence-based psychosocial interventions. Behaviors that challenge can be the consequence of a person’s unmet health or psychosocial need being psychosocial approaches the first-line treatments (Manthorpe and Moniz-Cook, 2020). In addition, people living in residential care require different workforce skills and resources compared with those living at home (James and Moniz-Cook, 2018). Other complex measures, such as DEMQOL-Proxy (Smith et al., 2005), have the potential to alter positively the area they are measuring, while being administered. This could be explained by the fact that by raising the correct questions, those answering (e.g. proxy carers) may identify potential positive changes to be made and start to implement them on their own initiative. It would be of interest to study if the sole administration of PGI-DSS has a therapeutic outcome on the management of behaviors that challenge by carers in residential home facilities. If this is the case, the assessment process would be a therapeutic intervention itself. Even though PGI-DSS has a very practical and compact format, its design is baroque and should be simplified, especially the reverse side of the protocol. In our opinion, the description of the four syndromes, linked with opportunities for timely interventions, is the core characteristic and value of International Psychogeriatrics (2020), 32:9, 1027–1029 © International Psychogeriatric Association 2020