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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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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.


An individualized care plan is essential to coordinate, document, and ultimately guide the care of people living with dementia and symptoms of agitation or aggression. The care plan is agreed upon by providers and caregivers to ensure consistent and coordinated delivery of care that considers the changing needs of people living with dementia. Ongoing review of the care plan supports the tracking of behavioural triggers and symptoms and allows for the assessment of treatment responses to interventions.

For Patients

A care plan should be created to meet your individual needs. A care plan is a written statement that describes the care you receive, who provides it, and what medications you are on. It is based on your full assessment.


For Clinicians

Work with people living with dementia, their caregivers, and substitute decision-makers to create an individualized care plan that documents behavioural symptoms and responses to interventions. For people in hospital inpatient settings, review and update care plans at least once each month. For people in long-term care homes, review and update care plans at least once every 3 months. Also update care plans every time there is a significant change in people’s health or care arrangements.


For Health Services

Ensure that hospitals and long-term care homes have standardized templates for developing care plans for people living with dementia. Ensure there are systems, processes, and resources in place to create and regularly update care plans.

Process Indicator

Percentage of people living with dementia and symptoms of agitation or aggression who have an individualized care plan

  • Denominator: total number of people living with dementia and symptoms of agitation or aggression who have had a comprehensive assessment

  • Numerator: number of people in the denominator who have an individualized care plan

  • Data source: local data collection

Percentage of people living with dementia and symptoms of agitation or aggression who have an individualized care plan that has been implemented

  • Denominator: total number of people living with dementia and symptoms of agitation or aggression who have an individualized care plan

  • Numerator: number of people in the denominator who receive care in concordance with their individualized care plan

  • Data source: local data collection

Percentage of people living with dementia and symptoms of agitation or aggression who have an individualized care plan that has been reviewed on a regular basis

  • Denominator: total number of people living with dementia and symptoms of agitation or aggression who have an individualized care plan

  • Numerator: number of people in the denominator who have an individualized care plan that has been reviewed on a regular basis (at least once each month in the inpatient setting; at least once every 3 months in long-term care)

  • Data source: local data collection


Structural Indicator

Availability of an electronic system that captures information about individualized care plans, including the plan itself and care associated with the plan

  • Data source: local data collection

Reviewed on a regular basis

The care plan is reviewed at least once a month in a hospital inpatient setting and every 3 months in a long-term care setting, or sooner according to clinical need.


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 or may not also be the person’s substitute decision-maker.

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