Older adults with dementia experiencing agitation and aggression
What are integrated care pathways?
An integrated care pathway (ICP) is a new approach at CAMH to treating a person who needs help. That person needs to see the right care providers, in the right order, in the right place, at the right time. An ICP makes sure this happens by identifying a care team of different professionals and mapping out the treatment process from start to finish. An ICP takes a structured, evidence-based approach to care, and it puts the person at the centre, resulting in better care.
ICPs have been used in some parts of the medical system for several decades. But it is only recently that they have been developed for mental illness and addictions care. This pathway for agitation and aggression in dementia was CAMH’s first ICP launched in 2013.
Who is on this ICP team?
The patient is at the centre of the team. Around them is a group of professionals communicating with each other about the treatment plan. The team includes a physician, a nurse, an occupational therapist, a recreation therapist, and a social worker. If it would be helpful for a particular patient, other professionals might also be involved. The team works with the patient, giving advice and recommending both medication-based and non-medication treatments during the person’s stay.
How does it work?
CAMH provides treatment for older adults with dementia who are experiencing agitation and aggression. These are common experiences among patients with Alzheimer’s dementia and are the main reason for Alzheimer patients to be hospitalized. When a patient is admitted, they are assessed to discover the cause of their agitation or aggression. This is to make sure that all possible factors are uncovered and that unnecessary or ineffective treatments are not used. If there is a clear diagnosis of dementia, the patient will enter the dementia ICP.
About the treatments
All ICPs at CAMH include both medication and non-medication treatment.
Medication: Different medications are tested in a structured way to see which, if any, works to reduce the patient’s aggression or agitation. Medications are stopped if they do not help. There are regular follow-up meetings with the physician to make sure the medications are working properly.
Non-medication treatment: Because everyone is different, patients are matched with treatments based on their individual needs and preferences. Treatments are aimed at improving the person’s overall well-being and quality of life. They are focused on improving social contact, physical health and increasing purposeful activities. Patients take part in daily individual and group programs, including individualized music, pet therapy, individual and group activities and exercises, social visits, access to outdoors and use of technology. The goals for each patient are reviewed throughout their stay. Patients stay on the unit long enough to achieve their goals, but not so long that being in the hospital gets in the way of the goals. When a patient leaves the pathway, family members or other caregivers are given education and support, including connecting them with community resources.
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