International Psychogeriatrics

Research Article

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

Victor Vicklanda1 c1, Natalie Chilkoa1, Brian Drapera1a2, Lee-Fay Lowa1, Daniel O'Connora3 and Henry Brodatya1a2

a1 Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia

a2 Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, Australia

a3 School of Psychology and Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia


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.

(Received August 17 2011)

(Revised November 01 2011)

(Revised December 14 2011)

(Accepted December 22 2011)

(Online publication March 16 2012)


c1 Correspondence should be addressed to: Dr. Victor Vickland, Dementia Collaborative Research Centre, Faculty of Medicine, University of New South Wales, NSW 2052 Australia. Phone: +61 2 9385-2626; Fax: +61 2 9385 2200. Email: