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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 ,
Natalie Chilko ,
Brian Draper ,
Lee-Fay Low ,
Daniel O'Connor  and
Henry Brodaty
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: [email protected].
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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.

Keywords

aggressiondementiaguidelinesbehavioral disturbancesBPSD
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 7 , July 2012 , pp. 1125 - 1132
Copyright
Copyright © International Psychogeriatric Association 2012

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