Individualized guidelines for the management of aggression in dementia - Part 1: Key concepts

Background: Clinical guidelines have the potential to assist in the management of aggression in dementia. This study aims to develop a conceptual framework for the construction of individualized guidelines for this group. Methods: A concept map of the topic “How to manage aggression in dementia” was developed by reviewing research papers, clinical guidelines, and gray literature. Titles and abstracts of papers that met search criteria were manually scanned in an iterative process for the extraction of key ideas and terminology commonly used to describe the field. Essential ideas and concepts were recorded on a concept map and hierarchically arranged. The concept map was converted into an interactive PDF document for easy distribution and sharing. Results: Ten key concepts were found to be important when managing aggression in dementia clustered along three major dimensions: Patient, Disorder and Treatment. The dimension Patient was defined by the “Patient's individual characteristics,” the “Personal life story,” and the “Patient's environment.” Disorder was defined by the “Presentation of symptoms” and “Theory of causation.” Treatment was defined by “Goals and expectations,” “Non-pharmacological interventions,” “Pharmacological interventions,” “Ethics and Restraint Use,” and “Emergency treatment.” Concepts relating to clinical guidelines themselves were also included in the interactive map, including “Support from evidence-based medicine,” “Regular updates,” “Disclosures,” and “Usability.” Conclusion: Managing aggression in dementia requires consideration of a wide range of factors relating to the patient, the dementia and behavioral disturbance, and possible treatment options. An interactive and hierarchical concept map provides a framework to develop individualized clinical guidelines.