Health Quality Ontario’s Behavioral Symptoms of Dementia Quality Standard provides guidance for the care of people living with dementia and the specific behaviours of agitation and aggression in the emergency department, while admitted to hospital, in a long-term care home, and in the transitions between these settings.
The quality standard includes 14 quality statements addressing areas that were identified as having high potential for improving the quality of care in Ontario for people with behavioural symptoms of dementia.
Below is a sample of tools and resources that may help you with the implementation of the quality statements into practice. Please also see the Behavioral Symptoms of Dementia Quality Standard for more tools and information, and its partnering quality standard, Dementia Care for People Living in the Community.
Are there other tools or resources you use? Do you have experience implementing these tools? If you have any feedback about any of these tools, please use the comments section below to share!
Tools and Resources for Each Quality Statement
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.
The quality standard lists six elements that should be included in a comprehensive interprofessional assessment for people with behavioral symptoms of dementia. Please see the Behavioral Symptoms of Dementia Quality Standard for more information.
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.
Please see the Behavioral Symptoms of Dementia Quality Standard for a full list of diverse, non-pharmacological interventions (e.g., aromatherapy, music, dance, massage, pet-assisted therapies, etc.) that may suit the individual’s preferences and needs.
- Responding to Behaviours Due to Dementia—a care planning guide developed by the Veterans Centre at the Sunnybrook Health Science Centre to help providers work with residents to achieve their best possible quality of life, in addition to the best clinical outcomes
- P.I.E.C.E.S.—a practical framework for assessment and supportive care strategies using a person-centred approach to support the care of older individuals living with complex chronic disease, including neurocognitive disorders and their associated behavioural changes
- Therapeutic Activity Kits—a tool with suggested therapeutic activity kit contents for adults with dementia
**Please note that statements 4–7 share the same tools and are grouped together below.**
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.
The following tools from statements 2 and 11 can also be used with this statement:
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.
Comprehensive Tools and Resources
The following tools and/or resources may apply to more than one quality statement in this quality standard.
Other Tools and Resources
The following are useful tools and/or resources for this quality standard topic that do not fall under any specific quality statements.
Comment below to describe your experience with these tools or share any others you have found useful!
This post is part of a series about how quality standards can be used to support quality improvement together, and provides a forum for people who are working on adopting the quality standards to share ideas and experiences. The introductory post can be found here.