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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.

For more information, contact QualityStandards@HQOntario.ca.



References

  1. Alzheimer Society of Canada. Dementia numbers in Canada [Internet]. Toronto (ON): The Society; c2016 [updated 2015 Apr 6; cited 2016 Jan 4]. Available from: http://www.alzheimer.ca/en/About-dementia/What-is-dementia/Dementia-numbers
  2. Finkel SI, Costa e Silva J, Cohen G, Miller S, Sartorius N. Behavioral and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment. Int Psychogeriatr. 1996;8 Suppl 3:497-500.
  3. Brodaty H, Draper B, Saab D, Low LF, Richards V, Paton H, et al. Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors. Int J Geriatr Psychiatry. 2001;16(5):504-12.
  4. O’Donnell BF, Drachman DA, Barnes HJ, Peterson KE, Swearer JM, Lew RA. Incontinence and troublesome behaviors predict institutionalization in dementia. J Geriatr Psychiatry Neurol. 1992;5(1):45-52.
  5. Wancata J, Windhaber J, Krautgartner M, Alexandrowicz R. The consequences of non-cognitive symptoms of dementia in medical hospital departments. Int J Psychiatry Med. 2003;33(3):257-71.
  6. Yaffe K, Fox P, Newcomer R, Sands L, Lindquist K, Dane K, et al. Patient and caregiver characteristics and nursing home placement in patients with dementia. JAMA. 2002;287(16):2090-7.
  7. Matsumoto N, Ikeda M, Fukuhara R, Shinagawa S, Ishikawa T, Mori T, et al. Caregiver burden associated with behavioral and psychological symptoms of dementia in elderly people in the local community. Dement Geriatr Cogn Disord. 2007;23(4):219-24.
  8. Clyburn LD, Stones MJ, Hadjistavropoulos T, Tuokko H. Predicting caregiver burden and depression in Alzheimer’s disease. J Gerontol B Psychol Sci Soc Sci. 2000;55(1):S2-13.
  9. Health Quality Ontario. Looking for balance: antipsychotic medication use in Ontario long-term care homes [Internet]. Toronto (ON): Queen’s Printer for Ontario; 2015 [cited 2016 Apr 8]. Available from: http://www.hqontario.ca/portals/0/Documents/pr/looking-for-balance-en.pdf
  10. Health Quality Ontario. Long-term care sector performance: quality indicators [Internet]. Toronto (ON): Queen’s Printer for Ontario; 2016 [cited 2016 Apr 8]. Available from: http://www.hqontario.ca/System-Performance/Long-Term-Care-Sector-Performance/Quality-Indicators
  11. Work Group on Alzheimer’s Disease and Other Dementias. Practice guideline for the treatment of patients with Alzheimer’s disease and other dementias [Internet]. Arlington (VA): American Psychiatric Association Publishing; 2007 [cited 2015 Mar 30]. Available from: http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/alzheimers.pdf. (Updated 2014; available from: http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/alzheimerwatch.pdf)
  12. Canadian Coalition for Seniors’ Mental Health. The assessment and treatment of mental health issues in long term care homes (focus on mood and behaviour symptoms) [Internet]. Toronto (ON): Canadian Coalition for Seniors’ Mental Health; 2006 [cited 2016 Jan 15]. Available from: http://www.ccsmh.ca/pdf/guidelines/NatlGuideline_LTC.pdf. (Updated 2014; available from: http://www.ccsmh.ca/pdf/guidelines/2014-ccsmh-Guideline-Update-LTC.pdf)
  13. Gauthier S, Patterson C, Chertkow H, Gordon M, Herrmann N, Rockwood K, et al. Recommendations of the 4th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD4). Can Geriatr J. 2012;15(4):120-6.
  14. National Institute for Health and Clinical Excellence, Social Care Institute for Excellence. Dementia: supporting people with dementia and their carers in health and social care [Internet]. London, UK: British Psychological Society and Gaskell; 2006 [cited 2015 Mar 13]. Available from: http://www.scie.org.uk/publications/misc/dementia/dementia-fullguideline.pdf
  15. Scottish Intercollegiate Guidelines Network. Management of patients with dementia: a national clinical guideline [Internet]. Edinburgh, Scotland: Scottish Intercollegiate Guidelines Network; 2006 [cited 2015 Mar 31]. Available from: http://www.sign.ac.uk/pdf/sign86.pdf
  16. Development Group of the Clinical Practice Guideline on the Comprehensive Care of People With Alzheimer’s Disease and Other Dementias. Clinical practice guideline on the comprehensive care of people with Alzheimer’s disease and other dementias [Internet]. Madrid, Spain: Spanish Ministry of Science and Innovation; 2010 [cited 2015 Mar 25]. Available from: http://www.guiasalud.es/GPC/GPC_484_Alzheimer_AIAQS_comp_eng.pdf
  17. Health Care Consent Act, 1996, S.O. 1996, c. 2, Sched. A, (1996).
  18. Substitute Decisions Act, 1992, S.O. 1992, c. 30, (1992).
  19. Health Care Consent Act, 1996, S.O. 1996, c. 2, Sched. A, ss. 25(6)-(7), (1996).

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