Barriers and facilitators to care for agitation and/or aggression among persons living with dementia in long-term care

Abstract

Background Agitation and/or aggression affect up to 60% of persons living with dementia in long-term care (LTC). It can be treated via non-pharmacological and pharmacological interventions, but the former are underused in clinical practice. In the literature, there is currently a lack of understanding of the challenges to caring for agitation and/or aggression among persons living with dementia in LTC. This study assesses what barriers and facilitators across the spectrum of care exist for agitation and/or aggression among people with dementia in LTC across stakeholder groups. Methods This was a qualitative study that used semi-structured interviews among persons involved in the care and/or planning of care for people with dementia in LTC. Participants were recruited via purposive and snowball sampling, with the assistance of four owner-operator models. Interviews were guided by the Theoretical Domains Framework and transcribed and analyzed using Framework Analysis. Results Eighteen interviews were conducted across 5 stakeholder groups. Key identified barriers were a lack of agitation and/or aggression diagnostic measures, limited training for managing agitation and/or aggression in LTC, an overuse of physical and chemical restraints, and an underuse of non-pharmacological interventions. Facilitators included using an interdisciplinary team to deliver care and having competent and trained healthcare providers to administer non-pharmacological interventions. Conclusions This study advances care for persons living with dementia in LTC by drawing attention to unique and systemic barriers present across local and national Canadian LTC facilities. Findings will support future implementation research endeavours to eliminate these identified barriers across the spectrum of care, thus improving care outcomes among people with dementia in LTC.

Detecting agitation and aggression in persons living with dementia: a systematic review of diagnostic accuracy

“…F-RAGE) [ 22 ]. In the literature, there is a lot of overlap and mixing between agitation and aggression among studies [ 59 ]. This issue makes it difficult to identify validity constructs for each separate symptom.…”

“…More research is thus needed to validate the most common agitation and/or aggression tools amongst PLWD to improve clinical research. Additionally we found no evidence on tools such as Behaviour and Symptom Mapping Tools and the Aggressive Behaviour Scale in the RAI-Minimum Data Set (MDS) 2.0 [ 59 ]. The Behaviour and Symptom Mapping Tools primarily notes behavioural trends in response to events, in a qualitative fashion, and are often a key part of assessing antecedent events for behaviors [ 61 ], so it is unlikely tools such as this may be compared to a reference standard.…”