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Evidence to Improve Care

Behavioural Symptoms of Dementia - Clinical Guide

Care for Patients in Hospitals and Residents in Long-Term Care Homes

Click below to see a list of brief quality statements and scroll down for more information.​​


Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence. ​

See below for the quality statements and click for more detail.​


Quality Statement 1: Comprehensive Assessment
People living with dementia and symptoms of agitation or aggression receive a comprehensive interprofessional assessment when symptoms are first identified and after each transition in care.


Quality Statement 2: Individualized Care Plan
People living with dementia and symptoms of agitation or aggression have an individualized care plan that is developed, implemented, and reviewed on a regular basis with caregivers and agreed upon by substitute decision-makers. Ongoing review and update of care plans includes documentation of behavioural symptoms and the person’s responses to interventions.


Quality Statement 3: Individualized Nonpharmacological Interventions
People living with dementia and symptoms of agitation or aggression receive nonpharmacological interventions that are tailored to their specific needs, symptoms, and preferences, as specified in their individualized care plan.


Quality Statement 4: Indications for Psychotropic Medications
People living with dementia are prescribed psychotropic medications to help reduce agitation or aggression only when they pose a risk of harm to themselves or others or are in severe distress.


Quality Statement 5: Titrating and Monitoring Psychotropic Medications
People living with dementia who are prescribed psychotropic medications to help reduce agitation or aggression are started on low dosages, with the dosage increased gradually to reach the minimum effective dosage for each patient, within an appropriate range. Target symptoms for the use of the psychotropic medication are monitored and documented.


Quality Statement 6: Switching Psychotropic Medications
People living with dementia who are prescribed psychotropic medications to help reduce agitation or aggression have their medication discontinued and an alternative psychotropic medication prescribed if symptoms do not improve after a maximum of 8 weeks. Ineffective medications are discontinued to avoid polypharmacy. The reasons for the changes in medication and the consideration of alternative psychotropic medications are documented.


Quality Statement 7: Medication Review for Dosage Reduction or Discontinuation
People living with dementia who are prescribed psychotropic medications to help reduce agitation or aggression receive a documented medication review on a regular basis to consider reducing the dosage or discontinuing the medication.


Quality Statement 8: Mechanical Restraint
People living with dementia are not mechanically restrained to manage agitation or aggression.


Quality Statement 9: Informed Consent
People living with dementia and symptoms of agitation or aggression are advised of the risks and benefits of treatment options, and informed consent is obtained and documented before treatment is initiated. If a person with dementia is incapable of consenting to the proposed treatment, informed consent is obtained from their substitute decision-maker.


Quality Statement 10: Specialized Interprofessional Care Team
People living with dementia and symptoms of agitation or aggression have access to services from an interprofessional team that provides specialized care for the behavioural and psychological symptoms of dementia.


Quality Statement 11: Provider Training and Education
People living with dementia and symptoms of agitation or aggression receive care from providers with training and education in the assessment and management of dementia and its behavioural symptoms.


Quality Statement 12: Caregiver Training and Education
Caregivers of people living with dementia and symptoms of agitation or aggression have access to comprehensive training and education on dementia and its associated behavioural symptoms. This training and education includes management strategies that are consistent with people’s care plans.


Quality Statement 13: Appropriate Care Environment
People living with dementia and symptoms of agitation or aggression whose behavioural symptoms have been successfully treated are transitioned to an appropriate care environment as soon as possible.


Quality Statement 14: Transitions in Care
People living with dementia and symptoms of agitation or aggression who transition between settings have a team or provider who is accountable for coordination and communication. This team or provider ensures the transmission of complete and accurate information to the family, caregivers, and receiving providers prior to the transition.

Health Quality Ontario thanks the following individuals for their generous, voluntary contributions of time and expertise to help create this quality standard:

Ilan Fischler (co-chair)
Medical Director,
Clinical Informatics and Geriatric Psychiatrist
Ontario Shores Centre for Mental Health Sciences

Tarek Rajji (co-chair)
Chief of Geriatric Psychiatry
Centre for Addiction and Mental Health

Carrie Acton
Administrator
Muskoka Landing— Jarlette Health Services

Saima Awan
Director, Integrated Care
Pathways Program, Centre for Addiction and Mental Health

Amer M. Burhan
Associate Professor and Chair of Geriatric Psychiatry
Schulich School of Medicine, Western University

Barry Joseph Goldlist
Professor
Department of Medicine, University of Toronto
Mount Sinai Hospital, University Health Network

K. Jennifer Ingram
Divisional Lead, Geriatric Medicine
Peterborough Regional Health Centre, Kawartha Regional Memory Clinic

Krista L. Lanctôt
Senior Scientist, Hurvitz Brain Science Program,
Sunnybrook Research Institute

Professor
University of Toronto

Denise Malhotra
Decision Support Analyst
Erie St. Clair Community Care Access Centre

Kathy McGilton
Senior Scientist
Toronto Rehabilitation Institution—University Health Network

Ashley Miller
Administrator
Regina Gardens Long Term Care Residence

Sandi Lynn Robinson
Lived Experience Advisor, Caregiver Education Coordinator
Acclaim Health, Alzheimer Services

Dallas Seitz
Assistant Professor
Division of Geriatric Psychiatry, Queen’s University

Richard W. Shulman
Service Medical Director, Seniors Mental Health Services
Trillium Health Partners

Assistant Professor
Division of Geriatric Psychiatry, University of Toronto

Vincci Tang
Deputy Chief Financial Officer and Director of Information
Technology and Decision Support, Ontario Shores Centre for Mental Health Sciences

Margaret Weiser
Psychologist, Private Practice
Lived Experience Advisor

Lori Whelan
Occupational Therapist
St. Michael’s Hospital

Evelyn M. Williams
President
Ontario Long Term Care Clinicians Head
Division of Long Term Care, Sunnybrook Health Science Centre

Ken Wong
Full-Time Caregiver

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