Behavioural and Psychological Symptoms of Dementia (BPSD)

Last Updated: April 30, 2025

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This tool is designed to help clinicians understand, assess, and manage people living with dementia (PLWD) in primary care and LTC homes living with behavioural and psychological symptoms of dementia (BPSD) (responsive behaviours). This tool integrates best-practice evidence with clinical experience, and makes reference to relevant existing tools and services wherever possible.

Important principles1-3:
  • Obtain informed consent, involve families/care partners at every step and consider preferences, values, culture and routines.
  • Adopt a strength-based approach when assessing PLWD with BPSD.  
  • Focus on individualized care while balancing benefits, risks and safety concerns. 
  • Review the underlying etiology of dementia and dementia stage, underlying causes, and specific BPSD (frequency, severity and risks). 
  • Evaluate biological, psychosocial and environmental contributors (e.g., delirium, pain, medication use, substance use, sensory impairments, sex, trauma, beliefs, cultural background, etc.). 
  • Use an interprofessional team and validated tools to guide care. 
  • Use person-centred, clear and appropriate language when engaging with PLWD, care partners or healthcare providers to reduce stigma and avoid negative labelling.
Overall BPSD approach1,3,5
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Assessment

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When assessing people living with dementia (PLWD) experiencing BPSD, confirming etiology is crucial, as it directly impacts treatment choices. This assessment should include1,3: 

Interviewing and assessing the PLWD

Interviewing care partners/informants, and

Reviewing prior health records and evaluations to date (e.g., cognitive testing, neuroimaging, functional ability/decline, activities of daily living (ADLs), etc).

If the etiology remains unclear, obtain further history and investigations as needed. Different dementia subtypes not only vary in BPSD frequency but also treatment response, affecting both safety and effectiveness1,3.

Identify risks and contributing factors1,3,4

Examine risks and contributors of BPSD related to the PLWD, care partners and their environment.

Risks:
  •  Interview family/care partner independently to ask about family/care partner strain and risk of self-harm or harm to others by the PLWD.  
  • Be mindful of any suggestions of harm by family/care partners.  
  • Consider using the PIECES™ RISKS mnemonic to assess risks to the PLWD and others. See PIECES box to the right. 
Contributing factors:
  • Evaluate biological factors (e.g., pain, constipation, acute illness, etc.).  
  • Understand personhood (e.g., sex, gender, sexual orientation, language, race, ethnicity, cultural background, trauma history, religious/spiritual beliefs).  
  • Identify psychosocial or environmental factors (e.g., education/training of care partners, changes to physical environment such as temperature, lighting, noise, familiarity of environment, etc.).  
  • Consider using a comprehensive tool such as the PIECES approach to investigate potential contributors. See PIECES box to the right.
History (include family/care partners):
  • Medication Review
    • Adherence, prescription and OTC medications, anticholinergic load*, drugs that may increase agitation, medication induced hypotension or orthostatic hypotension, medication that may contribute to constipation or urinary retention, medication that may impair cognition, substance use (e.g., alcohol, nicotine or cannabis), natural health products  
  • Mental health history
  • Sleeping patterns/sleep deprivation
  • Recent changes to environment, routine, family/social situation
  • Cognitive, functional and behavioural assessments 

*Consider using the Anticholinergic Burden Classification (ABC) scale. 

Physical examination:

Conduct a thorough physical examination to identify potential triggers for BPSD, including:

  • Sensory changes (e.g., ensure use of glasses and hearing aids), as sensory impairment can contribute to auditory or visual hallucinations. 
  • CNS changes (e.g., new stroke, neurodegenerative progression) 
  • Hydration/nutrition (e.g., dehydration, malnutrition) 
  • Hypo-perfusion (e.g., new atrial fibrillation, heart failure) 

 

Rule out other conditions/reversible causes:
Laboratory and imaging (as guided by physical exam/history):
  • Blood: Basic delirium workup (e.g., complete blood counts (CBC), electrolytes, glucose, calcium, creatinine, TSH, others) guided by the individual’s clinical presentation and co-morbidities. 
  • Imaging: If appropriate (e.g. chest x-ray if suspected pneumonia based on physical exam; CT head or MRI brain if new concerning neurologic findings).
  • Urine: Don’t order a urine culture unless minimum criteria for a UTI are present, as many older adults have asymptomatic bacteriuria. Consider using the following modified Loeb criteria37:
    • In a non-catheterized resident, the minimum criteria include:
      • Acute dysuria or
      • 2 or more of the following:
        • fever [> 37.9°C (100°F) or a 1.5°C (2.4°F) increase above baseline on at least two occasions over the last 12 hours], new or worsening urgency, frequency, suprapubic pain, gross hematuria, flank pain, urinary incontinence 
      • In a catheterized resident, minimum criteria include:
        • Any one of the following after alternate explanations have been excluded: fever [> 37.9°C (100°F) or a 1.5° C (2.4°F) increase above baseline on at least two occasions over the past 12 hours], flank pain, shaking chills, new onset delirium 

How to collect a urine culture: Don’t collect urine specimens that are likely to be contaminated (not urine hat or catheter bag). Use an approved sterile collection container. Non-catheterized residents should have a midstream urine if they are able, or alternatively, a urine sample collected through intermittent catheterization. Catheterized residents should have a new urinary catheter placed before collecting the first void if the catheter has remained in place for more than 14 days.

See Choosing Wisely Canada’s Antibiotics for Urinary Tract Infection in Older People resource for more information.

Cognitive, functional and behavioural assessments1,3,5

Cognitive, functional, and behavioral assessments are important for monitoring dementia and related symptoms. Cognitive assessments help establish a baseline and distinguish cognitive decline from other conditions (e.g., psychiatric disorders, delirium). Functional assessments evaluate activities of daily living (ADLs), identifying declines that may contribute to behavioral symptoms and signal disease progression. Behavioral assessments focus on understanding BPSD symptoms, their triggers and their impact.  

Consider using the following assessment tools: 

*May be subject to copyright. 

Resources

Consider using the interRAI Long Term Care Facilities (LTCF) instrument to assess persons in residential care facilities. Scales relevant to BPSD include the Composite Mood Scale (CMS), Depression Rating Scale (DRS), Aggressive Behaviour Scale (ABS), Revised Index of Social Engagement (RISE), and the Cognitive Performance Scale (CPS). In addition, the LTCF includes care planning protocols for these domain areas as well for delirium, appropriate medication use and restraints. For more information, see www.interRAI.org.3

Practice point3: While assessment scores (e.g., MoCA, MMSE) provide valuable insight, they must be interpreted in the context of the PLWD—scores alone do not dictate capacity to consent to treatment decisions. Avoid overgeneralizing results and use clinical judgment and input from informants to ensure a well-rounded evaluation.

Identifying BPSD

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Before implementing management strategies, it is important to identify the individual’s specific behavioural and psychological symptoms of dementia.  

Identifying BPSD symptom clusters1,3,8-11

agitation

Agitation
  • Dressing/undressing
  • Pacing
  • Repetitive actions
  • Restless/anxious

aggression

Aggression
  • Defensive
  • Resistant to care
  • Verbal or physical

psychosis

Psychosis
  • Delusions
  • Hallucinations
  • Misidentification
  • Suspiciousness

depression

Depressive symptoms and depression
  • Anxious
  • Guilt-ridden
  • Hopeless
  • Irritable/screaming

anxiety

Anxiety
  • Apprehensive expectation
  • Restless/sleep disturbance
  • Difficulty concentrating

expressions

Sexual expressions of risk
  • Sexualized language
  • Sexual gestures
  • Intrusive physical contact

mania

Manic symptoms
  • Euphoria
  • Irritable
  • Pressured speech

apathy

Apathy
  • Amotivation
  • Lacking interest
  • Withdrawn

Behavioural and psychological symptoms of dementia 1,3,8-13

Apply the International Psychogeriatrics Association (IPA) consensus criteria to diagnose agitation in individuals with cognitive disorders: 

  • an individual meets diagnostic criteria for cognitive impairment or a dementia syndrome;  
  • the individual expresses behaviours that are associated with observed or inferred distress, present for a minimum of two weeks or that are a significant change from their usual behaviour, which includes one or more of excessive motor activity, verbal aggression or physical aggression*;  
  • the behaviours cause excess distress and disability beyond what would be anticipated for the cognitive disorder, including impacts on relationships, social functioning or ability to perform independent activities; and,   
  • symptoms are not due to other psychiatric, general medical conditions, delirium, the care environment or substances. 

*Aggression refers to verbal and physical behaviour (hitting, throwing, etc.) with the potential to harm oneself or other. Aggression in people living with dementia can result in:

  • Poorer quality of life
  • Difficulty accomplishing their daily activities, and
  • Being more likely to be admitted to long0term facilities  

 

Consider using the following assessment tools to detect agitation:

Apply the International Psychogeriatrics Association (IPA) criteria for psychosis in major neurocognitive disorders to diagnose psychosis in dementia: 

  • the presence of either hallucinations or delusions;  
  • a diagnosis of major neurocognitive disorder due to Alzheimer’s disease or another etiology;   
  • the psychotic symptoms have not been continuously present prior to the onset of the major neurocognitive disorder;  
  • symptoms of psychosis present for at least one month;  
  • symptoms cause disruption or impairment in daily functioning or a safety concern for the person living with dementia (PLWD) or others; and,  
  • the symptoms are not accounted for by a pre-existing psychotic disorder such as schizophrenia, occurring only during a delirium, are due to effects of a substance or medical condition; the symptoms are not culturally appropriate, or are due to the effects of sensory impairment.  

Consider using the following assessment tool to detect psychosis:

 

The 2024 Canadian Coalition for Seniors’ Mental Health (CCSMH) guidelines recommend using the National Institute of Mental Health (NIMH) criteria for depression in Alzheimer’s disease to support the diagnosis of depression in people living with dementia (PLWD). These criteria, adapted from the DSM-4, account for the unique presentation of depression in this population. While the NIMH criteria were developed some time ago, they remain clinically relevant but can be challenging to apply in primary care due to time and resource constraints. As a result, some clinicians use alternative tools like the SIGECAPS mnemonic, based on DSM-5 criteria for major depressive disorder, which may be more practical in busy settings (or in mild to moderate cases). Care partner or informant reporting can also be valuable in gathering information and context.

Given the complexity of depressive symptoms in dementia, diagnosis requires careful clinical judgment that balances guideline recommendations with the realities of each practice and individual. 

Consider using the following assessment tools to detect depressive symptoms and depression:

 

Apply the Diagnostic and Statistical Manual of Mental Disorders–5–Text Revision (DSM-5-TR) criteria for diagnosing anxiety disorders in people living with dementia (PLWD):

  • excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance);
  • the individual finds it difficult to control the worry;
  • the anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months): 
    1. Restlessness or feeling keyed up or on edge 
    2. Being easily fatigued
    3. Difficulty concentrating or mind going blank
    4. Irritability
    5. Muscle tension
    6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)
  • the anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning;
  • the disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism); and,
  • the disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder, contamination or other obsessions in obsessive–compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

Consider using the following assessment tool to detect anxiety:

 

Sexual expressions of potential risk can be defined as a disruptive verbal or physical act of an explicit or perceived sexual nature, which is either intrusive or engaged in without the consent of those around the person living with dementia (PLWD). This includes: 

  • Hypersexuality 
  • Lewd/aberrant sexual behaviour* 
  • Inappropriate sexual advances* 
  • Inappropriate sexual comments* 
  • Socially disruptive sexually disinhibited behaviours  

*Given the subjective nature of “appropriate” vs “inappropriate,” focus on identifying sexual behaviours that may pose a risk to the PLWD or others. 

Consider using the following assessment tool to detect sexual expressions of risk:

Symptoms of mania in dementia (especially in late-stage disease) include:  

  • Euphoria (most common) 
  • Disinhibition (most common) 
  • Aberrant motor behaviour 
  • Sleep/appetite disturbances  
  • Pressured speech 
  • Agitation (can be related to other symptoms such as depression, mood disturbance, psychosis and hallucinations) 
  • Irritability (can be related to other symptoms such as depression, mood disturbance, psychosis and hallucinations) 

It is suggested that the prevalence of manic-like symptoms increases with severity of dementia.  

Consider using the following assessment tools to detect manic symptoms:

Apathy is one of the most persistent and common symptoms and can accelerate disease progression*. The 3 domains of apathy include:  

  • Deficits in goal-directed behaviour  
  • Decline in goal-related thought content 
  • Emotional indifference with flat affect 

Apathy in people living with dementia is influenced by multiple factors, including the person living with dementia (PLWD), care partner and environmental:  

Individual factors:

  • Demographic characteristics 
  • Severity of cognitive impairment 
  • Combination of other behavioural and psychological symptoms  
  • Acute medical problems or adverse drug reactions 
  • Unmet needs
  • Malnutrition

Care partner factors:

  • Emotional expressions of hostility or criticism towards the PLWD
  • High expectations of the person living with dementia leading to frustration and poor communication from the care partner

Environmental factors:

  • Too high or too low stimulation 
  • Lack of daytime activities

*Apathy is often missed as it is not as apparent or active as other behaviours. 

Consider using the following assessment tools to detect apathy:

Severity and impact1

  • Document the frequency, severity and impact of these symptoms on PLWD and care partners.  
  • Measure severity and impact of BPSD on the individual’s quality of life and daily functioning.

Acknowledging the severity of BPSD focusing on specific symptoms or syndromes can inform management strategies. Although assessments of severity are often subjective, categorizing BPSD in this way is intended to guide discussions about the potential risks and benefits related to management decisions.  

Categorizing BPSD severity
  1. BPSD cause minimal to no disruption in the environment;
  2. BPSD are associated with minimal distress to the person living with dementia; and,
  3. Symptoms are intermittent or easily modified by psychosocial approaches.

 

  1. BPSD cause some disruption to the environment;
  2. BPSD are associated with moderate distress for the person living with dementia; or,
  3. Symptoms are difficult to modify with psychosocial approaches.

 

  1. BPSD are associated with a risk of harm to the person living with dementia or others;
  2. BPSD are associated with severe and frequent disruption to the environment;
  3. BPSD are associated with severe distress to the person living with dementia; and,
  4. Minimal or no modification with psychosocial approaches alone.

Management

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Non-pharmacological management1,3

Non-pharmacological therapy is essential and considered the first-line therapy option for managing BPSD. It is an ongoing process that involves the care team, family and care partners.

It is vital to individualize your approach as much as possible. Behavioural triggers and effective ways to treat them will vary from one individual to the next and an individualized approach can drastically improve effects of non-pharmacological strategies.

Take advantage of any available system supports, such as Behavioural Supports Ontario (BSO), or Alzheimer Society of Canada’s First Link program. 

Even if non-pharmacological management is successful at managing symptoms, monitor targeted behaviours for changes and follow-up regularly based on the needs of the person living with dementia/care partner and severity of symptoms (see Follow-up and monitoring).

Develop a non-pharmacological care plan1

Create a care plan that is individualized and tailored to the individual’s unmet needs and unique interests.

Symptom-based interventions: 

Agitation
Agitation
  • Robotic pets 
  • Animal-assisted therapy 
  • Physical exercise (adapted to physical capabilities) 
  • Music-based interventions with preferred music 
  • Massage therapy 
  • Aromatherapy 
Psychosis
Psychosis
  • Consider psychosocial interventions found to be effective for managing other BPSD symptoms (e.g., music therapy, aromatherapy, robotic pets) 
Depressive symptoms
Depression
  • Personalized meaningful activities 
  • Animal-assisted therapy 
  • Robotic pets 
  • Cognitive stimulation therapy (CST) 
  • Massage and touch therapy 
  • Physical exercise (adapted to physical capabilities) 
  • Reminiscence therapy 
  • Home-based problem-based therapy 
  • Occupational therapy 
Anxiety
Anxiety
  • Cognitive behavioural therapy (CBT) for mild to moderate dementia (adapted for people living with dementia) 
  • Music therapy with preferred music 
Expressions
Sexual expressions of risk
  • Psychosocial approaches, such as removal of environmental triggers and engagement in other activities

Safety3

  • Ensure the individual’s safety and other PLWD safety by securing the environment
  • Make sure you are safe (close to exit, chair between you and the PLWD)
  • Remove potentially dangerous objects
  • Move other individuals away 
  • Remove ongoing triggers 
  • Educate care partners in safe approach and indications of need to withdraw for safety and encourage a safety plan

Pharmacological management

In some cases, when non-pharmacological approaches alone are not effective to manage BPSD, it may be necessary to initiate pharmacotherapy. 

Ensure pharmacotherapy is necessary3

Treat underlying causes (e.g., pain, constipation, delirium) and physical needs first (e.g., bladder issues, hearing aid batteries, etc.)

Ensure that non-pharmacological options were attempted and unsuccessful. 

In severe BPSD, if there is a safety risk to PLWD or others, there may not be time to try non-drug approaches before trying pharmacological management. Once non-pharmacological strategies are in place and safety concerns are reduced, consider deprescribing3.

Considerations for antipsychotic use

If you are considering initiating antipsychotic therapy, first ask: 

  • Are symptoms likely to respond to antipsychotics? (see Symptom cluster response to antipsychotic therapy) 
  • Is there imminent risk of harm to self and/or others? 
  • Are symptoms particularly disturbing, distressing or dangerous? 
  • Have you weighed the potential benefits and harms?

 

Prior to trialling antipsychotic therapy, it is vital to obtain informed consent from the PLWD or care partner. Consider using a conversation tracker to keep a record of decisions. 

Potential benefits and harms of antipsychotic therapy3,30

Potential benefits tend to be over-appreciated, while harms are underappreciated. Nevertheless, when harmful behaviours are severe and distressing, an antipsychotic trial may be reasonable for managing severe agitation and psychosis. 

Potential benefits

Limited benefit: modest improvement observed 

Potential harms 

  • Cerebrovascular events (highest probability: risperidone; lowest probability: quetiapine) 
  • Falls (highest probability: olanzipine; lowest probability: brexpiprazole) 
  • Sedation (highest probability: quetiapine; lowest probability: brexpiprazole) 
  • Extrapyramidal symptoms (highest probability: olanzipine; lowest probability: quetiapine) 
  • Urinary retention (highest probability: quetiapine; lowest probability: aripiprazole) 
  • Mortality 

Symptom cluster response to antipsychotic therapy3

Cluster

Likely

Unlikely

null

Agitation
  • Restless/anxious 
  • Pacing 
  • Exit seeking 
  • Repetitive actions 

aggression

Aggression
  • Defensive 
  • Physical 
  • Verbal 
  • Resistant to care

psychosis

Psychosis
  • Delusions 
  • Hallucinations 
  • Misidentification 
  • Suspicion 

N/A

manic symptoms

Manic symptoms

N/A

  • Irritable 
  • Pressured speech

apathy

Apathy

N/A

  • Amotivation 
  • Lack of interest 
  • Withdrawn 
other
Other

N/A

  • Hiding or hoarding 
  • Wandering without aggression (e.g., benign meaningless wandering (BMW)) 
  • Disinhibition (e.g., sexual)

Deprescribing antipsychotics1

When treating severe agitation or psychosis in BPSD with antipsychotics, best practice indicates treating with the lowest dose that is clinically effective for the shortest amount of time. Clinicians should: 

Reassess after 3 months of antipsychotic (AP) use and evaluate the reasoning for use and any recent changes in targeted behaviour(s)

Consider deprescribing APs if targeted symptoms are controlled, or there is no response to AP therapy

Consider deprescribing APs in PLWD with no history of severe agitation or psychosis, or a history of serious mental illness

Initiate deprescribing antipsychotics by decreasing the dose by 25-50% every 1-2 weeks until discontinued. PLWD should be closely monitored during tapering for signs of adverse drug withdrawal effects including psychosis, aggression, agitation, delusions and hallucinations. 

It is important to include PWLD/care partners in any deprescribing plan to reinforce understanding of rationale, potential for withdrawal symptoms and potential for relapse of BPSD symptoms.  

If the PLWD experiences a relapse in BPSD symptoms after deprescribing:

Consider non-pharmacological approaches to manage relapsed symptoms, see Non-pharmacological management.

Restart pharmacotherapy with antipsychotic and initiate second attempt of deprescribing after 3 months.

If symptoms relapse after second attempt to deprescribe, consider change in antipsychotic agent.

Pharmacotherapy follow-up1

Pharmacological management of BPSD should be routinely reviewed for potential discontinuation. 

Continue using non-pharmacological approaches to manage and prevent emergence of further BPSD symptoms. 

Follow-up and monitoring

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Treatment for dementia is an ongoing process. Since dementia is a progressive disease, regular follow-ups are necessary to ensure that the person living with dementia (PLWD) is receiving the best possible treatment for their symptoms.  

Guidance on follow-up5

Tracking treatment response should be personalized and consider multiple factors. It should not rely on a single tool or clinical domain (e.g., cognition, functional autonomy, behavior) and requires input from care partners or a reliable informant.  

When following up and reviewing medications, if the PLWD’s symptoms have worsened or persisted, consider referral to a specialist for a drug trial adjustment.  

Tailor the follow-up frequency to each individual’s circumstances. Factors such as severity, support level, and available resources will determine how often check ins are required. Evaluate the individual’s overall health, monitor the side effects of their medications, and assess their cognitive and non-cognitive symptoms related to dementia. The specific setting will depend on local healthcare services but should, at a minimum, include general practitioners with easy access to dementia specialists. 

While not every domain must be assessed at each visit, all should be reviewed at least once a year using the same assessment tools previously used. 

It is important to consistently review the effectiveness of the BPSD management plan and assess whether strategies need to be adjusted, modified, or discontinued.

Recommended tests and scales3,5

Assessing (instrumental) activities of daily living is an essential part of follow-up. The following are both familiar and validated to use:

Assessment of behaviour, personality or mood can be done with validated, familiar and simple tools, including:

Care partner burden3,5

Regularly assess care partner burden in the follow-up with PLWD as it is a major determinant of hospitalization and nursing home placement if they feel they can no longer provide care. The care partner will attend the visits and should be both included and monitored.  

Practice point3: Care partners’ health should be monitored as burnout can lead to physical and mental health strain that shouldn’t be overlooked. Provide support to help them manage their stress during this challenging time.

Use the following structured scales to assess how care partners are coping: 

Refer care partners to supports for education and counselling:

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    Choosing Wisely Canada. Using antibiotics wisely in long-term care [Internet]. 2024. Available from: https://link.cep.health/bpsdupdate74

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Use PIECES™ to identify risks and BPSD causes

Use the PIECES 3-Question Template ™ to ask:

  1. What are the priority concerns; is it a change for the person?
  2. What are the RISKS and possible contributing factors? Think PIECES Avoid assumptions! Think atypical!
  3. What are the actions?
  • Investigations
  • Interactions
  • Interventions

PIECES™ RISKS acronym to assess risks to the patient/resident and others: 

  • Roaming (e.g., searching, seeking exit) 
  • Imminent harm: frailty, falls, fire, firearms  
  • Suicide Ideation 
  • Kinship relationships (risk of harm by the person or to the person by others; includes avoidance of the person) 
  • Substance use, self-neglect, safe driving, security (e.g., finances, housing, food) 
PIECES Assessment:
Physical
  • Delirium
  • Disease
  • Discomfort
  • Drugs
  • Disability
Intellectual
  • Neurocognitive changes (e.g., amnesia, aphasia, agnosia, apraxia, etc.)
Emotional
  • Mood
  • Adjustment
  • Suicidality
  • Substance use
  • Psychosis
  • Trauma
Capabilities
  • Abilities overwhelmed/strengths underused
Environment
  • Enabling/disabling factors, transitions
Social
  • Life story, social network, cultural, spiritual, sexuality, gender identity

 

Visit PIECES Canada for more information.  

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Observing behavioural symptoms**

*DOS = Dementia Observation System (colours used in table are taken from DOS system, though you may use different colours in your practice)

**NOTE: The Dementia Observation System is primarily used in LTC settings. 

For more information and to see the full DOS tool, please visit Behavioural Supports Ontario.

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Creating a dementia-friendly environment3,14

Most residences are not designed to meet the needs of individuals living with BPSD. There are many aspects of an individual’s environment that impact quality of life and can trigger mood and behaviour changes.  

Adapting living environments can be an effective intervention strategy for managing BPSD. 

Consider providing care partners and/or family members with the following examples: 

Eliminate misleading stimuli 

  • Clutter, TV, radio, noise, people, reflections in mirrors/dark windows, pictures/décor 

Reduce environmental stress 

  • Extra/new people, public/visible TV, overhead glare, temperature control, privacy 
  • Avoid unsafe furniture and fixtures (sharp edges, hot water pipes, etc.) 
  • Avoid challenging the individual’s perception of reality 

Adjust stimulation 

  • If over-stimulated, reduce noise, activity, confusion 
  • If under-stimulated, increase activity/involvement 

Enhance function 

  • Increase lighting, to reduce misinterpretation
  • Add signs, cues, or pictures to promote way-finding 

Adapt the physical setting according to individual preference 

  • Secure outdoor areas 
  • Discrete safety features (handrails, grab bars, etc.) 
  • Home-like features 
  • Smaller, segmented recreational and dining areas 
  • Spa-like bathing facilities 
  • Promote an environment that encourages the involvement of family and friends (comfortable and close seating, family/care partner resources) 
  • Provide familiar and comforting items such as photo albums, favourite music, magazines 

 

For more guidance, refer to the Alzheimer’s Foundation of America’s booklet, The Apartment: A Guide to Creating a Dementia-Friendly Home.