General practitioners play a pivotal role in the care of a person with dementia and their families [
1]. It is estimated that there are currently 47 million people living with dementia worldwide, and this figure is predicted to triple by 2050 [
2]. In the context of rising dementia prevalence [
3], the dementia workload of general practitioners (GPs) is set to increase further. National dementia strategies have been developed internationally to respond to the challenge posed by increasing dementia prevalence and have emphasised the central role of GPs in successful implementation [
4‐
6]. GPs find many aspects of dementia care, such as diagnosis disclosure and co-ordinating support services, to be challenging [
7]. However, the one area that consistently emerges as a particularly challenging aspect of dementia care for GPs internationally is the management of behavioural and psychological symptoms of dementia (BPSD) [
7‐
11].
BPSD encompasses a wide range of symptoms and behaviours that affect people with dementia. BPSD includes behaviours such as aggression, wandering, sexual disinhibition and agitation and symptoms such as anxiety, depression and delusions. These symptoms and behaviours often overlap and occur together rather than occurring as isolated symptoms [
12]. The majority of people with dementia will experience BPSD [
13]. Estimates of BPSD prevalence vary [
14,
15], and we know the presence of BPSD can be influenced by several factors including dementia severity [
16]; however, some studies estimate that up to 80% of people with dementia experience at least one symptom of BPSD at some stage in their illness [
15]. The presence of BPSD results in increased rates of admission to long-term care facilities [
17,
18] and longer in-patient hospital stays [
19]. The development of BPSD is also associated with a worse prognosis for the patient and a more rapid rate of illness progression [
20]. From a carer perspective, BPSD is a major contributor to stress and depression, even more significant than cognitive decline [
21]. For physicians, the assessment of BPSD is complex, and effective treatment options are limited [
22]. Antipsychotics are associated with serious adverse effects including stroke [
23‐
25] and are not recommended unless there is a serious risk to self or others [
26]; however, credible pharmacological alternatives remain scarce [
27]. There is agreement that in most cases, non-pharmacological interventions should be used first line [
28]; however, effective non-pharmacologic strategies for BPSD have not been translated into real-world clinical practice [
29] and are not viewed by many GPs as being credible options [
30]. Many people with dementia experiencing BPSD may be under active care with secondary care services; however, GPs describe difficulty accessing advice from these services [
30,
31].
If GPs are to play the pivotal role described in the various national strategies, then interventions will be needed to support GPs in their management of BPSD; however, we are unaware of any such interventions. An important first step in intervention design is to establish a thorough understanding of existing behaviour [
32,
33]. To date, no qualitative or quantitative synthesis has been performed on studies which focused on GPs’ perspectives on the management of BPSD in community and residential care settings. Primary quantitative studies performed to date [
30,
34] have been conducted in different contexts and at different times in the evolution of the management of BPSD. Likewise, qualitative studies in this area [
35,
36] were conducted in different healthcare systems and took different approaches to the evidence. Exploring these contextual differences will improve the depth of our overall understanding of the research question. In order to effectively address our research aim, we will include both relevant quantitative and qualitative studies, as a review which “focuses exclusively on one form of evidence presents only half the picture and thus will have limited applicability” [
37].
The aim of this mixed methods systematic review is to develop a synthesis of qualitative and quantitative studies on GPs’ knowledge, attitudes and experiences of managing BPSD in order to develop a conceptual understanding of the perspective of GPs on the management of BPSD. The results of this systematic review will subsequently inform the development of a future behavioural change intervention.