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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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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.


Caregivers of people living with dementia and symptoms of agitation or aggression should be provided with the information and support services required to provide adequate care. In particular, they need to understand how to identify triggers for the person’s behaviours and how to use de-escalation techniques to help manage these behaviours. Understanding how to identify the needs of people living with dementia helps reduce occurrences of agitation or aggression and may also reduce caregiver stress and burden.

For Patients

Support and information should be provided to your family and other people who care for you so they can help you in the best possible way.


For Clinicians

Offer families and caregivers comprehensive training and education programs on dementia and its associated behavioural symptoms.


For Health Services

Ensure that hospitals and long-term care homes are able to offer families and caregivers comprehensive training and education programs on dementia and its associated behavioural symptoms.

Process Indicator

Percentage of caregivers of people living with dementia and symptoms of agitation or aggression who are offered access to comprehensive training and education on dementia and its associated behavioural symptoms

  • Denominator: total number of caregivers of people living with dementia and symptoms of agitation or aggression

  • Numerator: number of people in the denominator who have access to comprehensive training and education on dementia and its associated behavioural symptoms

  • Data source: local data collection

Percentage of caregivers of people living with dementia and symptoms of agitation or aggression who receive comprehensive training and education on dementia and its associated behavioural symptoms

  • Denominator: total number of caregivers of people living with dementia and symptoms of agitation or aggression

  • Numerator: number of people in the denominator who receive comprehensive training and education on dementia and its associated behavioural symptoms

  • Data source: local data collection

Structural Indicator Availability of comprehensive training and education programs on dementia and its associated behavioural symptoms for caregivers

  • Data source: local data collection

Caregivers

These are paid or unpaid people who help a family member, friend, or another person in need of assistance or support with daily living. In the case of a person with dementia, a caregiver may also be the person’s substitute decision-maker.

Caregiver training and education

This should include at minimum the following skills and information:

  • Dementia symptoms and disease progression

  • Prognosis and care plan strategy and monitoring

  • Benefits and risks of pharmacological and nonpharmacological treatment options

  • Detection of behavioural risks and de-escalation and management techniques

  • Causes of behavioural and psychological symptoms of dementia

  • Adaptive communication skills during times of stress

  • Functions of different professionals and health care settings

  • Medical-legal issues

  • Financial and legal planning for the person’s eventual incapacity

  • Advance care planning

  • Disagreement resolution processes for the person’s health care

  • Sources of local support services and groups

  • Sources of financial and legal advice and advocacy

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Claude Lurette and Kowsiya Vijayartnam, Health Quality Ontario Patient, Family and Caregiver Advisors Council Co-Chairs

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