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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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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.


Transitions between settings can pose problems in continuity of care for people living with dementia. Untimely or uncoordinated transition processes may delay treatment and increase the risk of behavioural symptoms being triggered. People living with dementia and their caregivers should be involved in the transition preparation process so their needs and questions are addressed. When they are aware of what will happen during the transition, they are empowered to play an active role. In addition, the most up-to-date information should be documented in the care plan by all providers. A provider or team should be accountable to ensure the accurate and timely transition of information to the proper recipients, to achieve a seamless transition process. Ultimately, transitions should be limited to only those that are beneficial or necessary.

For Patients

You should have a smooth transition between care environments.


For Clinicians

Ensure that people moving between providers or care settings have a person or team responsible for coordinating their care and transferring information among providers. Keep people living with dementia and their caregivers involved in and informed about their transition process.


For Health Services

Ensure that hospitals and long-term care homes have systems, processes, and resources in place to enable smooth transitions between care settings for people living with dementia.

Process Indicator

Percentage of people living with dementia and symptoms of agitation or aggression whose information is received by the new facility prior to their transition

  • Denominator: total number of people living with dementia and symptoms of agitation or aggression who transition to a new facility

  • Numerator: number of people in the denominator for whom complete and accurate transmission of information is received by the new facility prior to their transition

  • Data source: local data collection

Percentage of people living with dementia and symptoms of agitation or aggression whose information is incomplete or inaccurate when received by the new facility

  • Denominator: total number of people living with dementia and symptoms of agitation or aggression who transition to a new facility that has received information regarding their care and treatment

  • Numerator: number of people in the denominator whose care and treatment information is incomplete or inaccurate during the transition process

  • Data source: local data collection

Information

The following should be communicated to the patient, family, caregivers, and receiving providers prior to the transition:

  • Approaches to care

  • Updated care plan

  • Treatment history, including treatment options that have failed

  • Potential triggers for behavioural symptoms

  • Contact information for discharging and receiving providers

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