Developing a Novel Care Pathway for Symptoms of Agitation or Aggression in Persons Living with Dementia in Long-Term Care: A Multi-Methods Implementation Research Study
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2023-06
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Abstract
Background: Agitation and/or aggression are common among persons living with dementia (PLWD) in LTC, and together pose a significant burden to residents and their caregivers. Current treatment practices for agitation and/or aggression are highly variable among PLWD in LTC. There is a need to develop a more effective approach to treatment and to explore the barriers and facilitators to providing care for agitation and/or aggression among PLWD in LTC. Objectives: The first objective was to develop an evidence-informed clinical care pathway co-designed with stakeholders, to improve care for agitation and/or aggression among PLWD in LTC. The second objective was to identify barriers and facilitators to agitation and/or aggression care across the spectrum of care. Methods: Objective 1 used a modified Delphi panel to develop the clinical care pathway. Objective 2 used semi-structured interviews with key stakeholders to identify the barriers and facilitators to care. Framework Analysis was used to map identified barriers and facilitators to key behavioral domains of the Theoretical Domains Framework. Results: Crucial pathway features included using an interdisciplinary care team approach across the spectrum of care and featuring a broad range of non-pharmacological interventions. Several statements in our pathway did not reach agreement and require a third round of the Delphi. Perceived barriers for agitation and/or aggression care included a lack of validated tools to detect agitation and/or aggression, inconsistent training practices, and a limited number of available non-pharmacological interventions. Key facilitators were using an interdisciplinary care team and having trained healthcare providers to administer non-pharmacological interventions. Conclusions: Our study advances the state of evidence for agitation and/or aggression care among PLWD in LTC. Our efforts will inform future implementation research strategies working to improve the delivery and management of care. With more effective care approaches, the quality of life of PLWD in LTC will also improve.
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Wong, B. (2023). Developing a novel care pathway for symptoms of agitation or aggression in persons living with dementia in long-term care: a multi-methods implementation research study (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.