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Individualized guidelines for the management of aggression in dementia – Part 2: appraisal of current guidelines

Published online by Cambridge University Press:  16 March 2012

Victor Vickland*
Affiliation:
Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia
Natalie Chilko
Affiliation:
Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia
Brian Draper
Affiliation:
Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia
Lee-Fay Low
Affiliation:
Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia
Daniel O'Connor
Affiliation:
School of Psychology and Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
Henry Brodaty
Affiliation:
Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia
*
Correspondence should be addressed to: Dr. Victor Vickland, Dementia Collaborative Research Centre, Faculty of Medicine, University of New South Wales, NSW 2052Australia. Phone: +61 2 9385-2626; Fax: +61 2 9385 2200. Email: victor.vickland@unsw.edu.au.

Abstract

Background: Individualized guidelines have the potential to offer clinicians assistance in decision-making at the point of consultation to improve health outcomes for patients. This project aims to develop individualized guidelines for the management of aggression in dementia. At an earlier stage, we developed a map of concepts to consider when managing aggression. The purpose of the current study is to appraise paper-based guidelines for their representation of these concepts.

Methods: Two reviewers used a four-point scale (absent, weak, moderate, strong) to rate the guidelines on their representation of concepts relating to the patient, the aggression and dementia disorder, the treatment, and the guidelines themselves. Consensus was reached on inconsistent scores.

Results: Sixteen guidelines published since 2005 were evaluated for their representation of 13 key concepts. Pharmacological and non-pharmacological interventions were strongly represented overall in the guidelines, in conjunction with a consideration of the individual characteristics of the patients and their environment. Recommendations based on the presentation of the aggressive symptoms, goals of treatment, and theory of the cause of the aggression were moderately represented in the guidelines. Recommendations for the principles of restraint use and emergency treatment, as well as a consideration of the personal history of the patient, were poorly represented. Only 6 of 16 guidelines gave details of the expected review.

Conclusion: Concepts important to the management of aggression in dementia are missing in the majority of published guidelines on dementia. This limits the ability of these tools to guide clinical practice effectively.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2012

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References

Alexopoulos, G. S., Jeste, D. V., Chung, H., Carpenter, D., Ross, R. and Docherty, J. P. (2005). The expert consensus guideline series. Treatment of dementia and its behavioral disturbances. Introduction: methods, commentary, and summary. Postgraduate Medicine (Special report), 6–22.Google Scholar
Alzheimer's Disease International (2009). World Alzheimer Report. Available at: http://www.alz.co.uk/research/files/WorldAlzheimerReport.pdf; last accessed 15 July 2011.Google Scholar
American Association for Geriatric Psychiatry (2006). Position statement of the American Association for Geriatric Psychiatry regarding principle of care with dementia resulting from Alzheimer's disease. American Journal of Geriatric Psychiatry, 14, 561572.CrossRefGoogle Scholar
American Psychiatric Association (2007). Practice Guideline for the Treatment of People with Alzheimer's Disease and Other Dementias. Available at: http://www.psychiatryonline.com/pracGuide/pracGuideTopic_3.aspx; last accessed October 2010.Google Scholar
Ballard, C. and Corbett, A. (2010). Management of neuropsychiatric symptoms in people with dementia. CNS Drugs, 24, 729739.Google ScholarPubMed
Benoit, M. et al. (2006). Professional consensus on the treatment of agitation, aggressive behaviour, oppositional behaviour and psychotic disturbances in dementia. Journal of Nutrition, Health & Aging, 10, 410415.Google ScholarPubMed
British Colombia Medical Association (2008). Guidelines and Protocols: Cognitive Impairment in the Elderly – Recognition, Diagnosis and Management. British Colombia: British Colombia Medical Association, British Colombia Ministry of Health.Google Scholar
California Workgroup on Guidelines for Alzheimer's Disease Management (2008). Guidelines for Alzheimer's Disease Management: Final Report. Los Angeles: Alzheimer's Disease and Related Disorders Association.Google Scholar
Canadian Coalition for Seniors' Mental Health (2006). The Assessment and Treatment of Mental Health Issues in Long Term Care Homes (Focus on Mood and Behaviour Symptoms). Toronto: Canadian Coalition for Seniors’ Mental Health.Google Scholar
Dettmore, D., Kolanowski, A. and Boustani, M. (2009). Aggression in persons with dementia: use of nursing theory to guide clinical practice. Geriatric Nursing, 30, 817.CrossRefGoogle ScholarPubMed
Eddy, D. M., Adler, J., Patterson, B., Lucas, D., Smith, K. A. and Morris, M. (2011). Individualized guidelines: the potential for increasing quality and reducing costs. Annals of Internal Medicine, 154, 627634.CrossRefGoogle ScholarPubMed
Fletcher, K. (2008). Dementia. In Capezuti, E., Zwicker, D., Mezey, M., Fulmer, T. and Gray-Miceli, D. (eds.), Evidence-Based Geriatric Nursing Protocols for Best Practice, 3rd edn (pp. 83109). New York: Springer Publishing.Google Scholar
Garg, A. X. et al. (2005). Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA, 293, 12231238.Google Scholar
Grimshaw, J. M., Eccles, M. P., Walker, A. E. and Thomas, R. E. (2002). Changing physicians’ behaviour: what works and thoughts on getting more things to work. Journal of Continuing Education in the Health Professions, 22, 237243.CrossRefGoogle ScholarPubMed
Herrmann, N. and Gauthier, S. (2008). Diagnosis and treatment of dementia: 6. Management of severe Alzheimer disease. Canadian Medical Association Journal, 179, 12791287.CrossRefGoogle ScholarPubMed
Hillier, S. et al. (2011). FORM: an Australian method for formulating and grading recommendations in evidence-based clinical guidelines. BMC Medical Research Methodology, 11, 18.CrossRefGoogle ScholarPubMed
Lofgren, R. P., MacPherson, D. S., Granieri, R., Myllenbeck, S. and Sprafka, J. M. (1989). Mechanical restraints on the medical wards: are protective devices safe? American Journal of Public Health, 79, 735738.Google Scholar
Miyamoto, Y., Tachimori, H. and Ito, H. (2010). Formal caregiver burden in dementia: impact of behavioral and psychological dementia and activities of daily living. Geriatric Nursing, 31, 246253.Google Scholar
National Institute for Health and Clinical Excellence (NICE), Social Care Institute for Excellence (SCIE) (2007). Dementia: The NICE-SCIE Guideline on Supporting People with Dementia and Their Carers in Health and Social Care. Clinical Guideline 42. London: NICE-SCIE.Google Scholar
Royal Australian and New Zealand College of General Practitioners (2006). Dementia. In Medical Care of Older Persons in Residential Aged Care Facilities, 4th edn. Melbourne: The Royal Australian and New Zealand College of General Practitioners.Google Scholar
Royal Australian and New Zealand College of Psychiatrists (2009). Practice Guideline 10: Antipsychotic Medications as a Treatment of Behavioural and Psychological Symptoms of Dementia. Available at: http://www.ranzcp.org/resources/practice-guidelines.html; last accessed October 2010.Google Scholar
Royal College of Psychiatrists (2005). Forgetful but not Forgotten: Assessment and Aspects of Treatment of People with Dementia by a Specialist Old Age Psychiatry Service: Council Report. London: Royal College of Psychiatrists.Google Scholar
Rubin, B., Dube, A. and Mitchell, E. K. (1993). Asphyxial deaths due to physical restraint: a case series. Archives of Family Medicine, 2, 405408.CrossRefGoogle ScholarPubMed
Salzman, C. et al. (2008). Elderly patients with dementia-related symptoms of severe agitation and aggression: consensus statement on treatment options, clinical trials methodology, and policy. Journal of Clinical Psychiatry, 69, 889898.CrossRefGoogle ScholarPubMed
Scottish Intercollegiate Guidelines Network (2006). Management of Patients with Dementia: A National Clinical Guideline. Sign Publication No 86. Edinburugh: SIGN.Google Scholar
Sink, K. M., Holden, K. F. and Yaffe, K. (2005). Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA, 293, 596608.CrossRefGoogle ScholarPubMed
Sniderman, A. D. and Furberg, C. D. (2009). Why guideline-making requires reform. JAMA, 301, 429431.Google Scholar
Vickland, V., Chilko, N., Draper, B., Low, L-F., O'Connor, D. and Brodaty, H. (2012) Individualized guidelines for the management of aggression in dementia – Part 1: key concepts. International Psychogeriatrics (in this issue).CrossRefGoogle Scholar