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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.

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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.


People living with dementia and symptoms of agitation or aggression have complex needs and should receive individualized care by providers with comprehensive training and education in dementia and its behavioural and psychological symptoms. Identification and knowledge of the triggers for behavioural symptoms and the relevant treatment options allow for appropriate treatment and care strategies that meet people’s needs and help reduce the occurrence of symptoms. Training and education materials or programs should be tailored specifically to providers’ roles and responsibilities.

For Patients

You should receive care from a team of health care professionals who have been trained to treat symptoms of agitation and aggression.


For Clinicians

Ensure that you have the training and education required to effectively provide care for people living with dementia and symptoms of agitation and aggression, in accordance with your professional role. This includes identifying and avoiding triggers for behavioural symptoms, and developing strategies for managing these symptoms if they occur.


For Health Services

Ensure health care professionals caring for people living with dementia in hospitals and long-term care homes have training and education in managing dementia and associated behavioural symptoms.

Process Indicator

Percentage of providers who care for people living with dementia who have received training and education in the assessment and management of dementia and its behavioural symptoms

  • Denominator: total number of health care providers who care for people living with dementia

  • Numerator: number of people in the denominator who have received training and education in the assessment and management of dementia and its behavioural symptoms

  • Data source: local data collection


Structural Indicator

Providers who care for people living with dementia have access to staff with training and education in the assessment and management of dementia and its behavioural symptoms

  • Data source: local data collection

Provider training and education

TThese should include at minimum the following skills and information:

  • Comprehensive assessment of people living with dementia

  • Dementia symptoms and disease progression

  • Specific subtypes of dementia

  • Early identification of behavioural risks

  • Appropriate use of pharmacological and nonpharmacological treatment options

  • De-escalation strategies for challenging behaviours

  • Communication with patients, residents, and caregivers

  • Coordination of multidisciplinary care

  • Impacts of dementia on patients, caregivers, families, and social networks

  • Ethical and medical legal considerations

  • Detection of and strategies to manage abuse and neglect

  • Palliative care

  • Outreach strategies to connect patients, residents, and caregivers with available resources

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