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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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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.


The law requires that providers obtain capable, informed, and voluntary consent prior to initiating a treatment, as stated in the Health Care Consent Act, 1996. In addition, people living with dementia may be assessed for decision-making capacity. If it is determined they do not have the capacity to make decisions with respect to the proposed treatment, a legal substitute decision-maker may be appointed; this is outlined in the Substitute Decisions Act, 1992. Treatment may be initiated without consent in the event of an emergency situation, where people living with dementia and symptoms of agitation or aggression are at risk of causing serious bodily harm to themselves or others or are experiencing severe suffering. According to legislation, “treatment may be continued only for as long as reasonably necessary” to obtain consent from the substitute decision-maker, or from the person with dementia if they regain the capacity to make their own decision. In either case, the provider must document justification of the treatment, and the patient’s values and wishes must always be considered when making a medical decision.

For Patients

No changes should be made to your treatments until you have been given information about their benefits and harms and have agreed to these changes. In very rare circumstances, where someone is at risk of being hurt, you might be treated first and then provided with information as soon as possible.


For Clinicians

Provide information on and discuss the risks and benefits of different treatment options with patients, their caregivers, or substitute decision-makers. Always obtain and document informed consent before initiating or stopping a treatment. If a person is unable to consent, obtain informed consent from their substitute decision-maker.


For Health Services

Ensure that all important information on people’s capacity to consent and their substitute decision-makers (if applicable) is documented and accessible in hospitals and long-term care homes.

Process Indicator

Percentage of people living with dementia and symptoms of agitation or aggression receiving a medical treatment whose informed consent (obtained directly or from the substitute decision-maker) is documented prior to the initiation of the treatment

  • Denominator: total number of people living with dementia and symptoms of agitation or aggression who are receiving a medical treatment

  • Numerator: number of people in the denominator whose informed consent (directly or by substitute decision-maker) is documented prior to initiation of the treatment

  • Data source: local data collection

Incapable

In this context, being incapable is a person’s inability to make appropriate decisions. Capacity is always considered with respect to the proposed treatment that requires consent. A person’s capacity can fluctuate depending on the proposed treatment and timing. A person can be capable with respect to some proposed treatments, but incapable for others. Similarly, capacity can be present for a proposed treatment at one time but absent at another time.

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