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Improving Quality of Life in the Elderly by Standardizing Care for Neuropsychiatric Symptoms of Dementia

Principal Investigator:
  • Tarek Rajji, Centre for Addiction and Mental Health
Team Members:
  • Amer Burhan, London Health Sciences Centre
  • Simon Davies, Centre for Addiction and Mental Health
  • Philip Gerretsen, Centre for Addiction and Mental Health
  • Ariel Graff, Centre for Addiction and Mental Health
  • Zahinoor Ismail, University of Calgary
  • Sanjeev Kumar, Centre for Addiction and Mental Health
  • Paul Kurdyak, Centre for Addiction and Mental Health
  • Benoit Mulsant, CAMH, University of Toronto
  • Vasavan Nair, Douglas Hospital Research Centre
  • Bruce Pollock, Centre for Addiction and Mental Health
  • Claire de Oliveira, Centre for Addiction and Mental Health
  • WBHI
  • Michael Smith Foundation for Health Research
  • St Paul's Foundation
  • UBC Faculty of Medicine

Project Overview

Aggression and agitation are common symptoms among patients with dementia. These symptoms are the leading cause for hospitalization and admission to long-term care homes. Medication treatments that are commonly used to treat these symptoms have significant adverse effects including falls, stroke and increased risk of death. These adverse effects are more common with inappropriate use of these medications. To address this, a standardized approach, the Integrated Care Pathway (ICP), was developed to treat agitation and aggression in dementia. The ICP consists of a step by step treatment algorithm and predetermined assessments at each stage. The ICP was successfully implemented at the Geriatric Inpatient Unit at the Centre for Addiction and Mental Health (CAMH) and resulted in better outcomes with a lower use of medications and reduced rate of falls.

In this study, the team proposes to test this approach across Canada in other academic hospitals and long-term care homes. The group will enroll 220 participants with agitation/aggression due to dementia at 7 sites (4 inpatient units and 3 long term care homes) across Canada. Participants will be randomized to the ICP or treatment as usual. Data will be collected on clinical parameters such as agitation, falls, medication use, caregiver burden as well as about economic impact of care. Comparisons will be made between the ICP and usual care. If successful, this project will help guide clinical care to treat agitation/aggression in dementia and will improve the quality of life for patients with dementia and their caregivers. It will also help reduce health care costs and guide further research in this field.