[Recommendations for diagnosis and therapy of behavioral and psychological symptoms in dementia (BPSD)]

In patients with dementia, Behavioral and Psychological Symptoms of Dementia (BPSD) are frequent findings that accompany deficits caused by cognitive impairment and thus complicate diagnostics, therapy and care. BPSD are a burden both for affected individuals as well as care-givers, and represent a significant challenge for therapy of a patient population with high degree of multi-morbidity. The goal of this therapy-guideline issued by swiss professional associations is to present guidance regarding therapy of BPSD as attendant symptoms in dementia, based on evidence as well as clinical experience. Here it appears to be of particular importance to take into account professional experience, as at this point for most therapeutic options no sufficiently controlled clinical trials are available. A critical discussion of pharmaco-therapeutic intervention is necessary, as this patient-population is particularly vulnerable for medication side-effects. Finally, a particular emphasis is placed on incorporating and systematically reporting psycho-social and nursing options therapeutic intervention.

[Caregivers of elderly patients suffering from mental disorders]

Mental disorders in the elderly lead their families to stand in and adopt a variety of roles before institutional care takes over. These pathologies carry a high risk of suffering for families and distress for professional caregivers. Thus, the psychological burden endured by the proxies of an elderly depressed patient, or of one who has committed suicide, or of patient suffering from dementia needs special attention and, in some cases, professional care. The discussion of these paradigmatic situations in this manuscript will be extended by a paragraph on specific stakes raised by alcoholic patients living in nursing homes. It will stress the complexity and requirements of professionalism when approaching the familial and professional circle of the elderly psychiatric patient.

[New challenges in old age]

Old age, with its inevitable succession of bereavement and loss, is a difficult time of life, and is often a cause of suffering on both an individual and a family level. The crises of aging, such as retirement, dependency or old age, bring a person face-to-face with their finiteness, creating anxiety and raising questions related to death. These are times of intense instability, which can lead either to personal growth through a process of adaptation and a rebuilding of one's self-image, or to a dysfunctional approach and an increase in suffering, through resistance to change. Through its work, the therapist aims to assist the elderly person to cope more serenely with the frustrations of the external reality and to come to terms with their future death.