Quality Statement 4: Indications for Psychotropic Medications

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 Statements in Brief

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.

Resources Quality Statements Advisory Committee About

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.

Background

Because of their potential for adverse events, psychotropic medications should not be considered first-line therapy for people living with dementia. In particular, the use of antipsychotics is cautioned for people living with dementia as it is associated with an increased risk of serious adverse events, such worsening cognition, parkinsonism, diabetes, sedation, cerebrovascular disease, and premature death. Nonpharmacological interventions should be considered first-line therapy for people living with dementia, and psychotropic medications should be used only when people pose a risk of harm to themselves or others or are in severe distress.

What This Quality Statement Means

For Patients

Medications should be used only if you are in severe distress or if there is a concern you might harm yourself or someone else.

For Clinicians

Only prescribe psychotropic medications to reduce agitation or aggression in people living with dementia when they pose a risk of harm to themselves or others or are in severe distress. If psychotropic medications are prescribed, provide information to people and their caregivers about the risks and side effects of the medication, the rationale for prescribing it, and the plan for reviewing and reducing or discontinuing its use.

For Health Services

Ensure that hospitals and long-term care homes have systems, processes, and resources in place to document the rationale, plan for review, and provide information to people living with dementia and their caregivers when psychotropic medications are prescribed.

Quality Indicators

Process Indicator

Percentage of people living with dementia and symptoms of agitation or aggression who are prescribed a psychotropic medication typically used to reduce distress, without clear documentation that they are in severe distress or pose a risk of harm to themselves or others

Denominator: total number of people living with dementia with symptoms of agitation or aggression who are prescribed a psychotropic medication typically used to reduce distress
Numerator: number of people in the denominator who are prescribed the psychotropic medication without clear documentation that they are in severe distress or pose a risk of harm to themselves or others
Data source: local data collection

Definitions Used Within This Quality Statement

Psychotropic medications

These categories of psychotropic medications are typically used for reducing symptoms of agitation and aggression in people living with dementia:

Antipsychotics
Antidepressants
Mood stabilizers
Benzodiazepines
Other hypnotics

Evidence to Improve Care