Implementing and sustaining evidence-based practices in long-term care.

Delirium, Dementia and Depression Responsive Behaviours

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    This nursing Best Practice Guideline (BPG) is intended to replace the RNAO (2010) BPGs Screening for Delirium, Dementia and Depression in Older Adults and Caregiving Strategies for Older Adults with Delirium, Dementia and Depression. It is to be used by nurses and other members of the interprofessional health-care team to enhance the quality of their practice pertaining to delirium, dementia, and depression in older adults, ultimately optimizing clinical outcomes through the use of evidence-based practices.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

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    3Ds Gap Analysis

    Organizational assessment tool to assist with implementation and evaluation of the RNAO Delirium, Dementia, and Depression in Older Adults: Assessment and Care BPG by comparing current practice to evidence-based practice. Source: Registered Nurses' Association of Ontario's Long-Term Care Best Practices Program, Toronto, ON. August 2016.

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    The case study and its accompanying discussion guide were developed for educational purposes in long-term care homes to promote use of the RNAO Delirium, Dementia, and Depression in Older Adults: Assessment and Care BPG. This resource provides the necessary instructions to hold a facilitated discussion with long-term care staff.  Overall goals of the case study and discussion guide are to:

    • Actively engage participants in discussions about delirium, dementia, and depression
    • Help long-term care staff identify the differences between delirium, dementia, and depression
    • Help long-term care staff become familiar with key resources they can use at the point-of-care to support identification of delirium, dementia, and depression
    • Reinforce best practices for the care of delirium, dementia, depression in older adults

    Reference: Registered Nurses’ Association of Ontario. (2017). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

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    The 4AT is a validated rapid assessment test for delirium and cognitive impairment. It is widely used in routine clinical practice in the UK and internationally. It is free for download and use.

    Reference: MacLullich, A., Ryan, T. and Cash, H. (2014). 4AT Rapid Assessment Test for Delirium. Retrieved from http://www.the4at.com/

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    Abbey Pain Scale is an assessment tool for the measurement of pain in people with dementia who cannot verbalize

    Source: Dementia Care Australia Pty Ltd. Website: www.dementiacareaustralia.com

    Reference: Abbey, J; De Bellis, A; Piller, N; Esterman, A; Giles, L; Parker, D and Lowcay, B. Funded by the JH & JD Gunn Medical Research Foundation 1998 – 2002 (This document may be reproduced with this acknowledgment retained)Retrieved from: http://www.wales.nhs.uk/sitesplus/documents/862/FOI-286f-13.pdf

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    This template is helpful in identifying and altering the antecedent and consequences to change behaviour.

    Registered Nurses’ Association of Ontario. (2012). Appendix L of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (p. 113). Retrieved from https://rnao.ca/sites/rnao-ca/files/Promoting_Safety_-_Alternative_Approaches_to_the_Use_of_Restraints_0.pdf

    Source: Omelan, C. (2006). CME: Approach to Managing Behavioural Disturbances in Dementia. Canadian Family Physician, February, 52, p. 193 Reprinted with permission from the Canadian Family Physician

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    The ACE Website provides materials for public education on prevention of elder abuse. Materials include information on powers of attorney, consumer protection and legal issues affecting older persons.

    Advocacy Centre for the Elderly (ACE) (2013) Retrieved from http://acelaw.ca

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    This heart-warming video shows how music can transform the life of a resident with dementia.

    Reference: Sundance Film Festival. (2014, January 7) Alive Inside: A Story of Music & Memory Featurette - Documentary HD. Retrieved from https://youtu.be/8HLEr-zP3fc

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    This Alzheimer Canada website section provides resources for health care professionals on the following topics: Ambiguous Grief and Loss, Pain, End of Life and Culture Change

    Retrieved from http://www.alzheimer.ca/en/We-can-help/Resources/For-health-care-professionals

    2017 Alzheimer Society of Canada. All rights reserved.

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    This organization provides support to families and clients affected by Alzheimer’s disease. Links are provided to a chapter near you. Web site is also available in French.  Website: www.alzheimer.ca/en/on.

    The Website is copyrighted by the Alzheimer Society of Canada.

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    This table from Appendix K pages 152-153 of the BPG Delirium, Dementia and Depression in Older Adults: Assessment and Care (2016) helps us reflect on our own attitudes, skills and knowledge about dementia and provides tips for successful interpersonal skills with residents with dementia.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

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    The Website provides resources and presentations on Behaviour Supports Ontario. View the Behavioural Education and Training Supports Inventory (BETSI) and many other behavioural links and resources in Ontario.  Alzheimer Knowledge Exchange Resource Centre's Website: www.akeresourcecentre.org/BSO.

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    The BSO-DOS© is an observational tool that helps to identify patterns of behaviour for care planning purposes. It is based on the former DOS. Simple registration is required to access this free tool. A user guide and resource manual are available.

    Behavioural Supports Ontario. (2019). Behavioural Supports Ontario - Dementia Observation System. Retrieved from https://brainxchange.ca/BSODOS

     

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    This report provides rationale for using person-centred care language and helpful strategies for changing practice.

    Behavioural Supports Ontario. (October, 2018). Behavioural Supports Ontario person-centred language initiative report. Retrieved from http://www.behaviouralsupportsontario.ca/Content/Pledge/BSO_Person-Centred_Language_Initiative_Report%20_October_2018.pdf

     

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    This intervention toolkit provides links to universally recognized behavioural assessment tools for common responsive behaviours. The toolkit describes possible behavioural causes and a range of strategies to help with care planning.

    Reference:Central East Local Health Integration Network (LHIN) Behavioural Supports Ontario Education Committee (n.d.) Central East LHIN Behavioural Supports Ontario Intervention Tool Kit, retrieved from http://centraleast.behaviouralsupportsontario.ca/Uploads/ContentDocuments/Intervention%20Tool%20Kit_Version%201_May_2016.pdf  

    Acknowledgements: This tool was created by the Central East Local Health Integration Network (LHIN) Behavioural Supports Ontario Education Committee. Acknowledgment to the Psychogeriatric Resource Consults of the Central East Region for developing this tool. Thank you to the Central East Long-Term Care Homes for contributing to the development of the tool.

    Disclaimer: Permission to use, copy, modify, and distribute this material for educational, research, and not-for-profit purposes, without fee and without a signed licensing agreement, is hereby granted, provided that the above copyright notice, this paragraph and the following paragraphs appear in all copies, modifications, and distributions. Contact Terry Donaghue, Technology Transfer & Industrial Liaison, Mount Sinai Hospital, & The Samuel Lunenfeld Research Institute, 600 University Avenue, Toronto, ON Canada M5G 1X5, Tel. (416) 586-8225, Fax (416) 586-3110, E-mail: donaghue@mshri.on.ca for commercial licensing opportunities.

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    This HQO quality standard addresses care for people living with dementia and the specific behaviours of agitation and aggression. Accompanying resources include a Patient and Resident Reference Guide and Recommendations for adoption.

    Reference: Health Quality Ontario (2016). Behavioural Symptoms of Dementia. Care for Patients in Hospitals and Residents in Long-Term Care Homes. Retrieved from http://www.hqontario.ca/Evidence-to-Improve-Care/Quality-Standards/View-all-Quality-Standards/Behavioural-Symptoms-of-Dementia/ 

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    The Stroke: Behaviour Issue BP Blogger enhances learning about stroke and behaviours in LTC. BP Bloggers present credible bite-size pieces of information on clinical topics related to LTC.

    Web Source: www.rgpc.ca

    Reference: Myth Busting: Stroke 6:Behaviour Issue . (Late Fall, 2016). BP Blogger, 10 ,(1). Retrieved from Regional Geriatric Program central © Copyrighted. All Rights Reserved MLvanderHorst.

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    This Delrium BP Blogger enhances learning about delirium. BP Bloggers present credible bite-size pieces of information on clinical topics related to LTC. 

    Myth Busting: The Delirium Issue.  (April-May 2008). BP Blogger, 3,(3).  Retrieved from Regional Geriatric Program Central. © Copyrighted. All Rights Reserved MLvanderHorst.

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    The Dementia BP Blogger enhances learning about dementia care. BP Bloggers present credible bite-size pieces of information on clinical topics related to LTC. 

    Myth Busting: The Dementia Care Issue.  (February 2009). BP Blogger, 4,(1).  Retrieved from Regional Geriatric Program Central. © Copyrighted. All Rights Reserved MLvanderHorst.

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    The Wandering BP Blogger enhances learning about wandering. BP Bloggers present credible bite-size pieces of information on clinical topics related to LTC. 

    Myth Busting: The Wandering Issue.  (November/December 2007). BP Blogger, 2,(10).  Retrieved from Regional Geriatric Program Central. © Copyrighted. All Rights Reserved MLvanderHorst.

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    Canadian Dementia Resource and Knowledge Exchange (CDRAKE) and Alzheimer Knowledge Exchange (AKE) have amalgamated to create this new hub of dementia resources. Contained within are links to Behaviour Support Ontario (BSO), Psychogeriatric Resource Consultants (PRC) and many resources pertinent to dementia and responsive behaviours.

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    This helpful table from Appendix D (page 127) of the BPG Delirium, Dementia and Depression in Older Adults: Assessment and Care (2016) helps to distinguish among delirium, dementia and depression where features are often similar or overlapping.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

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    Confusion Assessment Method (CAM) helps identify individuals who may be suffering from delirium or an acute confusional state and is useful for distinguishing between delirium and dementia. There are choices such as the long or short version CAM or the 3D CAM.

    Reference: Hospital Elder Life Program (2003). Confusion Assessment Method. Retrieved from http://www.hospitalelderlifeprogram.org/delirium-instruments/

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    This on-line resource provides information and resources concerning seniors with developmental disabilities, including strategies and support for aging with developmental disabilities and dementia. There is a drop down selection choice including relevant topics, articles and news in regard to older people with developmental disabilities and changes due to aging.

    Web Source and Copyright: http://connectability.ca/category/seniors/ Community Living Toronto- Information presented on this website, www.connectability.ca is considered public information (unless otherwise noted) and may be distributed or copied provided that it includes acknowledgement that the material was sourced from www.connectability.ca

    Reference: Community Living Toronto, 2016, Connect Ability.ca, retrieved from http://connectability.ca/category/seniors/  

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    Nurses have ethical and legal obligations for obtaining consent. The ethical obligations related to consent are discussed in the Ethics practice standard under the section Client Choice. This practice guideline replaces and updates the guide produced in June 1996 after the legislation, the Health Care Consent Act (HCCA) and the Substitute Decisions Act (SDA), was enacted. This practice guideline provides an overview of the major features of the legislation, pertinent definitions, the steps nurses need to take to obtain consent and the Guidelines for Nurses Advocating for Clients Found Incapable of Making Certain Decisions. It replaces an earlier Guide to the Health Care Consent and Substitute Decisions Legislation for RNs and RPNs. It does not address consent under the Mental Health Act.

    Reference: College of Nurses of Ontario Practice Guideline (2009) Consent Retrieved from http://www.cno.org/globalassets/docs/policy/41020_consent.pdf

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    This conversation sheet from Alzheimer Canada informs how dementia can affect intimacy and sexuality. Strategies are provided for caregivers. There is also a section to support LGBTQ persons with dementia.

    The Alzheimer Society is Canada’s leading health charity for people living with Alzheimer’s disease and other dementias. For more information visit the home page www.alzheimer.ca  

    Alzheimer Canada (2018). Conversations about dementia, intimacy and sexuality. Retrieved from https://alzheimer.ca/sites/default/files/files/national/brochures-conversations/conversations_intimacy-and-sexuality.pdf

     

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    The I-WATCH-DEATH mnemonic is widely used in clinical practice to help health-care providers remember common causes of delirium, and helps support bedside assessments.

    Reference: Wise, M. G. (1986). Delirium. In R. E. Hales & S. C. Yudofsky (Eds.), American Psychiatric Press Textbook of Neuropsychiatry (pp. 89–103). Washington, DC: American Psychiatric Press Inc. Retrieved from Family Medicine Reference http://www.fammedref.org/mnemonic/differential-diagnosis-i-watch-death  

    Copyright 2015 Stamp Forge

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    Appendix G from pages 133-134 of Delirium, Dementia and Depression in Older Adults: Assessment and Care (2016) identifies risk factors and related interventions for delirium.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

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    The delirium toolkit defines delirium and looks at prevention as well as management strategies in multiple settings, including within long-term care.

     Regional Geriatric Program of Toronto. (2019). Senior friendly care: Delirium toolkit. Retrieved from: https://www.rgptoronto.ca/wp-content/uploads/2018/11/SF7-Toolkit-Delirium.pdf

    © 2019 Regional Geriatric Program of Toronto. All Rights Reserved.

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    This presentation reviews risk factors and care strategies for vascular dementia. 

    van der Horst, M. (July 24, 2007).  Dementia and Stroke. [PowerPoint slides].   Retrieved from www.rgpc.ca/

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    Indigenous Cognitive and Aging Awareness Research Exchange (I-CAARE) offers a number of factsheets, a health wheel and pathway for persons with dementia and their caregivers. The indigenous perspective may provide added support and comfort to families as they journey through dementia.

    Reference: Indigenous Cognitive and Aging Awareness Research Exchange (2018). Dementia Factsheets. Retieved from https://www.i-caare.ca/factsheets 

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    Social Care Institute for Excellence is an improvement support agency in the UK that aims to improve health-care quality and support services. Look for dementia resources and the eLearning program.

    Reference: Social Care Institute for Excellence Website: http://www.scie.org.uk/dementia/

    All material on this website, including text, graphics photographs and video, is copyright of the Social Care Institute for Excellence (SCIE), unless otherwise stated. Text and graphics may be freely reproduced for the purposes of any personal or educational use or private research. However, the use of any text, graphics, photographs or video contained in this website for any commercial purposes is not authorised unless permission is first obtained from SCIE.

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    Learn more about living with dementia in these videos from Teepa Snow. She has used multi-modal therapies to support people living with dementia and their caregivers. You will find links to the following videos:

    • Dementia 101
    • Teepa's GEMS
    • Brain Changes
    • Challenging Behaviours
    • Meaingful Activities, and
    • Music

    You can also visit the website http://teepasnow.com/

    Refrence: Video Links for Tips from Teepa, 2016. Retrieved from http://teepasnow.com/resources/teepa-tips-videos/

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    Les présentes lignes directrices sur les pratiques exemplaires, Développement et maintien des soins de santé interprofessionnels : optimisation des résultats pour le patient/client, l’organisme et le système sont conçues pour favoriser des milieux de travail sains. L’objectif de l’élaboration de ces lignes directrices était de déterminer les attributs des soins interprofessionnels qui permettront d’optimiser les résultats de qualité pour les patients/clients, les fournisseurs, les équipes, l’organisation et le système. Les présentes lignes directrices déterminent les pratiques exemplaires pour faciliter, améliorer et maintenir le travail d’équipe ainsi que la collaboration interprofessionnelle, et pour accroître les résultats positifs pour les patients/clients, les systèmes et les organisations. Elles sont fondées sur les meilleures données probantes existantes; lorsque ces données étaient limitées, les recommandations ont été fondées sur un consensus basé sur des opinions d’experts.

    Association des infirmières et infirmiers autorisés de l’Ontario. (2013). Développement et maintien des soins de santé interprofessionnels : optimisation des résultats pour le patient/client, l’organisme et le système. Toronto, Canada: Autheur. Récupéré: http://rnao.ca/bpg/language/d%C3%A9veloppement-et-maintien-des-soins-de-sant%C3%A9-interprofessionnels-optimisation-des-r%C3%A9sul

    Ce travail est financé par le Ministère de la Santé et des Soins de longue durée d'Ontario.

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    The DOLOPLUS-2 Scale can be used for people having mild or moderate cognitive impairment and with proxy rating when a person is unable to self-report.

    Reference: Registered Nurses Association of Ontario (2013) Appendix M of Assessment and Management of Pain, Third Edition. Toronto, ON, Canada Author p. 95

    Used with permission from: Fuchs-Lacelle & Hadistavroplous, 2004; Hadistavropolous et al, 2006: Herr et al, 2011: Lefebvre-Chapiro & the DOLOPLUS Group, 2001: Schofield et al, 2008

    Website: http://www.assessmentscales.com/scales/doloplus

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    Une pratique efficace des soins infirmiers dépend d’une relation thérapeutique efficace entre le client et l’infirmière. Cette Ligne directrice porte sur les qualités d’une relation thérapeutique efficace, sur les possibilités qu’elle offre, sur l’état des connaissances et sur les connaissances requises afin de pouvoir travailler efficacement dans une relation thérapeutique. Afin qu’une relation thérapeutique puisse être instaurée avec succès, les valeurs du milieu de travail et les caractéristiques essentielles de l’établissement doivent être en place et doivent être compatibles avec cet objectif. Une feuille de travail sur le niveau de préparation de votre établissement est compris.

    Association des infirmières et infirmiers autorisés de l’Ontario. (2002). Établissement de la relation thérapeutique. Toronto, Canada: Autheur. Récupéré: https://rnao.ca/sites/rnao-ca/files/Etablissement_de_la_relation_therapeutique.pdf

    Ce travail est financé par le Ministère de la Santé et des Soins de longue durée d'Ontario.

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    This resource from pages 94-98 of Delirium, Dementia and Depression in Older Adults: Assessment and Care (2016) includes structure, process and outcome indicators helpful in evaluating the changes made by an organization.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

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    Alzheimer Society Ontario's Finding Your Way® helps people living with dementia, their families, caregivers and communities to recognize the risk of going missing, be prepared for incidents of going missing, and ensure that people with dementia can live safely in the community. At this link you will find free On-line Learning about keeping people with dementia safe. You will also find a Living Safely with Dementia Resource Guide and an interactive resource guide. http://findingyourwayontario.ca/ 

    Alzheimer Society of Canada (2018). Finding Your Way. http://findingyourwayontario.ca/ 

    2018 Alzheimer Society of Canada

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    This flow chart from page 33 of the BPG Delirium, Dementia and Depression in Older Adults: Assessment and Care (2016) provides a concise and systematic overview of the best practice recommendations.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

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    This web link provides GPA training information and educational resources. access to GPA newsletters. The Advanced Gerontological Education Website is www.ageinc.ca.

     

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    The GDS is a screening tool to facilitate the assessment of depression in older adults. It is available in both long form and short form versions and also in multiple languages.

    Reference: Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37–49. Retrieved from https://web.stanford.edu/~yesavage/GDS.html

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    This table from page 76-77 of the Delirium, Dementia, Depression in Older Adults: Assessment and Care BPG (2016) reviews interventions for depression, including psychotherapy, psychological/social and antidepressants.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

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    Kingston Standardized Behavioural Assessment (KSBA) complements cognitive assessment tools by providing an indication of the number of behavioural symptoms associated with dementia that are currently affecting an individual. There are both community and long-term care versions available.

    Reference: R.W. Hopkins, L.A. Kilik (May 2016). Kingston Standardized Behavioural Assessment Long-term Care Form. Retrieved from http://www.kingstonscales.org/behaviour-assessment.html

    Copyright Kingston Scales. All rights reserved.

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    This e-resource offered by Baycrest provides six sections of learning including understanding depression, signs and symptoms, self-check, causes, types and treatments for late-life depression.

    Reference: Baycrest Health Sciences (2016) Late-Life Depression. Retrieved from http://www.baycrest.org/educate/mental-health/depression/

     

    © 2016 BAYCREST HEALTH SCIENCES - ALL RIGHTS RESERVED. UNAUTHORIZED COPYING, REPRODUCTION, REPUBLISHING, UPLOADING, DOWNLOADING, POSTING, TRANSMITTING OR DUPLICATING ANY OF THE MATERIAL FOUND ON THIS WEBSITE IS PROHIBITED. Your use of this site constitutes your agreement to abide by these Terms of Use. Baycrest reserves the right, in their sole discretion, to modify, alter or otherwise update these Terms of Use at any time and you agree to be bound by such modifications, alterations or updates. You agree to review these Terms of Use on an ongoing basis. Baycrest hereby grants you a personal, non-exclusive, non-assignable and non-transferable license to use and display, one copy of any Material and/or software that you may download from this site, including, but not limited to, any files, codes, audio or images incorporated in or generated by the software (collectively called the “Downloaded Material”) provided, however, that you must maintain all copyright and other notices contained in such Downloaded Material. You acknowledge and agree that you may not sublicense, assign or otherwise transfer this license or the Downloaded Material and that no title to the Downloaded Material has been or will be transferred to you from Baycrest or anyone else. You also agree that you will not alter, disassemble, decompile, reverse engineer or otherwise modify the Downloaded Material.

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    This WHO webpage, Mental Health of Older Adults, recognizes dementia and depression in older adults as a global public health issue and identifies interventions.

    World Health Organization. (12 December, 2017). Mental Health of Older Adults. Retrieved from www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults

    Licence: CC BY-NC-SA 3.0 IGO.

     

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    The Mini-Cog is a brief screening instrument to determine memory recall and clock drawing ability. A positive screen would suggest more in-depth assessment for cognitive impairment. Mini-Cog instrument, instructions and scoring are provided.

    Reference: Borson, S. (n.d.). Mini-Co. Retrieved from https://mini-cog.com/

    Mini-Cog™ © S. Borson. All rights reserved. Reprinted with permission of the author solely for clinical and educational purposes. May not be modified or used for commercial, marketing, or research purposes without permission of the author (soob@uw.edu). v. 01.19.16

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    Mobilization- Observation- Behaviour-Intensity- Dementia Pain Scale (MOBID) is a nurse-administered instrument to observe pain behaviours during guided movements.

    Reference: Husebo, B. S., Strand, L. I., Moe- Nilssen, R., Husebo, S. B., Snow, A. L., & Ljunggren, A. E. (2007). Mobilization-Observation- Behaviour-Intensity-Dementia Pain Scale (MOBID): Development and validation of a nurse-administered pain assessment tool for use in dementia. Journal of Pain and Symptom Management, 34(1), 67–80. Retrieved from - http://www.nccdp.org/resources/MOBID1.article.pdf

    2007 U.S. Cancer Pain Relief Committee Published by Elsevier Inc. All rights reserved.

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    A useful tool for assessing early stage dementia.  For more information or feedback on MoCA© contact Dr Z. Nasreddine at info@mocatest.org.

    Nasreddine, Z.  (2003). Welcome to the Montreal Cognitive Assessment.   Quebec, QC, Canada: Center for Diagnosis & Research on Alzheimer’s disease.  Retrieved from www.mocatest.org.  Copyright Dr Z. Nasreddine 2003 to 2013 - The Montreal Cognitive Assessment - MoCA© - All rights reserved.

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    Music and Memory looks at how music can enrich the lives of long-term care residents with cognitive impairment.

    Reference: Blanchard, Laurie (2016). Music and Memory. Retrieved from http://libguides.lib.umanitoba.ca/ld.php?content_id=25047510

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    National Initiative for the Care of the Elderly (NICE) is an international network of researchers, practitioners, and students dedicated to improving the care of older adults in Canada and abroad. The website includes various resources, some specific to dementia care and caregiving.

    Reference:National Initiative for the Care of the Elderly (NICE) Website: http://www.nicenet.ca/

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    Neuropsychiatric Inventory (NPI) is used to assess behavioural and psychological symptoms in clients with dementia. It evaluates the frequency and severity of the following symptoms: delusion, hallucinations, agitation, depression/dysphoria, anxiety, euphoria/jubilation, and apathy/indifference, disinhibition, irritability/lability, motor behaviour without a purpose, sleep alteration, and eating disorder. It is used to assess behavioural and psychological symptoms in patients

    Reference: Wood S, Cummings JL, Hsu M-A, Barclay T, Wheatley MV, Yarema KT, Schnelle JF. The use of the Neuropsychiatric Inventory in nursing home residents, characterization and measurement. Am J Geriatr Psychiatry 2000; 8: 75-83. http://www.dementia-assessment.com.au/behavioural/NPI.pdf

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    This Table from page 61 of Delirium, Dementia and Depression in Older Adults: Assessment and Care (2016) describes non- pharmacological approaches to use to minimize behavioural and psychological symptoms of dementia.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

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    The Office of the Public Guardian and Trustee (“OPGT”) delivers a unique and diverse range of services that safeguard the legal, personal and financial interests of certain private individuals and estates. Services are provided by multi-disciplinary teams of dedicated staff with experience in the health care, social work and financial planning fields. They receive professional support from lawyers, accountants and investigators. A brief description of many of the services offered by the OPGT is set out in the website.

    Reference: Office of the Public Guardian and Trustee (OPGT)

    Website: https://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/overview.php

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    This website provides information and resources about the P.I.E.C.E.S.™ program. "Putting the P.I.E.C.E.S.™ Together" represents Physical, Intellectual, Emotional, Capabilities, Environment, Social, and are the cornerstones of the philosophy and care of the P.I.E.C.E.S.™ approach.

    P.I.E.C.E.S.™ (n.d.). P.I.E.C.E.S. website. Retrieved from http://pieceslearning.com/

     

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    PACSLAC is a tool to observe and assess both common and subtle pain behaviours. Copyright © Shannon Fuchs-Lacelle and Thomas Hadjistavropoulos. The PACSLAC may not be reproduced without permission. For permission to reproduce the PACSLAC, please contact the copyright holders (Thomas.Hadjistavropoulos@uregina.ca).

    Retrieved from http://www.geriatricpain.org/content/Assessment/Impaired/Pages/default.aspx

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    Comprehensive pain assessment tool for use in cognitively intact adults with pressure injuries. This pain assessment tool is useful for people with dementia who are unable to verbally express their pain. It focuses on behaviours and provides the ability to score pain levels.

    Reference: Interior Health. Retrieved from http://bcbpsd.ca/docs/part-1/Final%20Provincial%20PAINAD%20Scale.pdf

     

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    The Parkinson Canada website contains several useful resources for LTC including a Guide to the Non-Motor Symptoms of Parkinson's Disease (client and physician versions). These guides cover cognitive dysfunction, dementia, anxiety, depression, delusions and impulse control in Parkinson's disease. Also available is a booklet specific to the LTC sector as well as a medication booklet.

    Reference: Parkinson Canada website, retrieved from http://www.parkinson.ca/

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    Partnerships in Dementia Care Alliance (PiDC) helps to change culture in long-term care and community settings to enhance dementia care. Examples of culture change in LTC homes is included.

    Reference: Partnerships in Dementia Care Alliance Website: https://uwaterloo.ca/partnerships-in-dementia-care/

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    This list of suggestions helps staff provide an approach to minimize responsive behaviours.

    Registered Nurses’ Association of Ontario. (2009). Appendix D-9 of Preventing and Managing Violence in the Workplace. Toronto, ON, Canada: Author. pp.  118. Retrieved from http://rnao.ca/bpg/guidelines/preventing-and-managing-violence-workplace.  This work is funded by the Ontario Ministry of Health and Long-Term Care.

    OSACH Website: www.osach.ca/

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    Proper preparation can greatly decrease the risk of a violent incident with a potentially violent resident. Communication and other strategies are provided to considered when in contact with a resident who could potentially be violent.

    Registered Nurses’ Association of Ontario. (2009). Appendix D-14 of Preventing and Managing Violence in the Workplace. Toronto, ON, Canada: Author. pp.  132-133. Retrieved from http://rnao.ca/bpg/guidelines/preventing-and-managing-violence-workplace.  

    OSACH Website: www.osach.ca/

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    This North Simcoe Muskoka Specialized Geriatric Services resource considers behavioural risks and PIECES needs to offers suggestions for prescribing and de-prescribing antipsychotics.

    Web Address or Source: http://www.nsmsgs.ca/Uploads/ContentDocuments/9.%20Antipsychotic%20Toolkit%20May17.pdf

    Reference: North Simcoe Muskoka Specialized Geriatric Services (May 30, 2017). Promoting the Appropriate Use of Antipsychotics. Retrieved from http://www.nsmsgs.ca/Uploads/ContentDocuments/9.%20Antipsychotic%20Toolkit%20May17.pdf 

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    The provincial RAI-MDS© and P.I.E.C.E.S.™ Integration Working Group have developed a Job Aid that allows for the streamlining of the RAI assessment and the P.I.E.C.E.S. 3-Question Assessment and Care Planning Framework.

    Retrieved from: http://piecescanada.com/index.php?option=com_content&view=article&id=27&Itemid=30

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    This resource from Sunnybrook's Veterans Centre integrates scientific evidence with the resident's abilities and wishes. It promotes collaborative care planning that is creative and leads to the resident's desired life experience.

    © 2010, Sunnybrook Health Sciences Centre Veterans Centre. All rights reserved. Responding to Behaviours Due to Dementia using Achieving Best Life Experience (ABLE) Care Planning Guide. The ABLE Care Planning Guides are intended for use beyond Sunnybrook’s Veterans Centre. It is our hope that our ABLE guides will provide interprofessional staff working in complex continuing care facilities and nursing homes with an easily accessible resource to use with residents and families in planning and delivering care that is focused on what is important to each resident.

    Reference: J. Charles, S. Greenwoord & S. Buchanan (2010), Responding to Behaviours Due to Dementia: Achieving Best Life Experience (ABLE) Care Planning Guide. Toronto. Sunnybrook Veterans Centre.

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    The “Responsive Behaviours—Clinical and Organizational Change Concepts and Ideas” poster is a Health Quality Ontario resource that outlines key steps in a responsive behaviour quality improvement plan.

    Reference: Health Quality Ontario (2011). Responsive BehavioursPoster. Retrieved from http://www.hqontario.ca/portals/0/documents/qi/rf-poster-responsive-behaviours-en.pdf

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    The link takes you to the responsive behaviours section 53 of the Ontario Regulation 79/10 made under the Long-Term Care Homes Act, 2007, Government of Ontario. Retrieved from https://www.ontario.ca/laws/regulation/r10079  

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    This table from page 71 of the Delirium, Dementia, and Depression in Older Adults: Assessment and Care BPG (2016) looks at predisposing and precipitating risk factors as well as signs of depression.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

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    Gain an overview of the most compelling evidence about diversity; understanding it, accepting the differences it brings to work settings, and finally, to seeking and embracing diversity.

    This panel has been developing guidelines that recommend a congruent set of work place behaviours, management practices and institutional policies within a practice setting resulting in an organizational environment that is respectful and inclusive of cultural and other forms of diversity.

    Registered Nurses’ Association of Ontario.  (2017).  RNAO Embracing Cultural Diversity in Health Care: Developing Cultural Competence. Toronto, ON: Author. https://rnao.ca/sites/rnao-ca/files/Embracing_Cultural_Diversity_in_Health_Care_-_Developing_Cultural_Competence.pdf

     This work is funded by the Ontario Ministry of Health and Long-Term Care

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    The purpose of this Guideline is to provide evidence-based recommendations that promote and sustain the undergraduate nursing student’s application of knowledge to practice in a variety of clinical learning environments. The Guideline explores the relationships among and between students and nursing educators, nursing staff, preceptors, and diverse health-care team members, and it considers their influence on the quality of practice education, professional socialization, and nursing excellence. The recommendations will help nurse educators, preceptors, staff nurses, and other members of the interprofessional health-care team better understand how to foster and support effective teaching and learning strategies in a variety of practice settings, as well as how they can advocate for change.

    Registered Nurses’ Association of Ontario (2016). Practice Education in Nursing. Toronto, Canada: http://rnao.ca/bpg/guidelines/practice-education-nursing

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    Effective nursing practice is dependent on an effective therapeutic relationship between the nurse and the client. This guideline addresses the qualities and capacities of an effective therapeutic relationship, the state of knowledge, and the knowledge needed to be effective. To implement a therapeutic relationship successfully, an organization's characteristics and workplace values must be supportive and in place. An organization readiness assessment based on the best practice recommendations is provided. Supplement: 2006

    Registered Nurses’ Association of Ontario. (2002). Establishing therapeutic relationships. Toronto, ON, Canada: Author. Retrieved from https://rnao.ca/sites/rnao-ca/files/Establishing_Therapeutic_Relationships.pdf

     This work is funded by the Ontario Ministry of Health and Long-Term Care

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    This Guideline provides evidence-based recommendations for nurses and other members of the interprofessional team across all care settings who are assessing and providing interventions to individuals who use substances and may be at risk for or experiencing a substance use disorder.

    Registered Nurses’ Association of Ontario (2015). Engaging Clients Who Use Substance. Toronto, Canada: http://rnao.ca/bpg/guidelines/engaging-clients-who-use-substances

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    Increase your knowledge in promoting family health through interventions and supports provided during expected (i.e. birth, school, adolescence, aging, and death) as well as unexpected (i.e. trauma/accidents, chronic illness, developmental delay and disability) life events. Focusing on the family is an integral component of nursing practice. This guideline was developed to promote and facilitate continuing education, reflection and reaffirmation of the importance of caring for families. Supplement: 2006

    Registered Nurses’ Association of Ontario. (2002). Supporting and Strengthening Families Through Expected and Unexpected Life Events. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/supporting-and-strengthening-families-through-expected-and-unexpected-life-events

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    This website provides information on joining communities of practice including the following: Aging & Developmental Disabilities, Communication Access & Aphasia, Mental Health and Behavioural Support. (Formerly called Seniors Health Research Transfer Network).  Website: http://seniorshealthknowledgenetwork.ca/home

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    This Australian sexuality assessment tool provides a gap analysis style and scoring system to assist with policy development within the long-term care setting.

    Bauer, M., Fetherstonhaugh, D., Nay, R., Tarzia, L. & Beattie, E (2013). Sexuality Assessment Tool (SexAT) for residential aged care facilities.  (Available from the Australian Centre for     Evidence Based Aged Care, La Trobe University, Melbourne VIC 3086). Retrieved from https://www.privacy.org.nz/assets/Uploads/Sexuality-Assessment-Tool-SexAT.pdf

    ©  La Trobe University, as represented by the Dementia Collaborative Research Centre – Carers and Consumers

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    SIG E CAPS is a mnemonic used to recall the most frequent symptoms of depression (prescription for energy capsules).

    Reference: Jenike, M. A. (1989). Geriatric psychiatry and psychopharmacology: A clinical approach. Chicago, IL: Yearbook Medical Publishing. http://www.unmc.edu/media/intmed/geriatrics/reynolds/pearlcards/depression/sigecaps.htm

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    This poster from the Regional Geriatric Program of Toronto reveals 6 strategies to prevent and manage delirium.

    Regional Geriatric Program of Toronto. (n.d.). Six proven strategies to prevent delirium in older adults. Retrieved from https://www.rgptoronto.ca/wp-content/uploads/2019/01/Delirium-prevention-PRINT.pdf

    © 2019 Regional Geriatric Program of Toronto. All Rights Reserved.

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    Cette affiche du Regional Geriatric Program de Toronto nous donne 6 stratégies pour prévenir et soutener le délire.

    Regional Geriatric Program of Toronto. (n.d.). Six stratégies éprouvées pour prévenir le délire chez la personne âgée. Récupéré de https://www.rgptoronto.ca/wp-content/uploads/2019/01/Delirium-prevention-PRINT-French.pdf

    © 2019 Regional Geriatric Program of Toronto. All Rights Reserved.

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    The Ontario Stroke Network has prepared numerous care plans for residents in LTC with strokes. Some of the care plans are particularly applicable to residents with stroke dementia, including those on behaviour change, cognition, communication, depression and perception.

    Reference: Website: http://ontariostrokenetwork.ca/stroke-qbp-resource-centre/stroke-rehabilitation-resource-centre/clinical-tools-and-resources-for-implementation/clinical-tools-resources-implementation-community-re-engagement/

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    This Government of Ontario website contains the Substitute Decisions Act and Regulations that fall under it.

    Reference: Substitute Decisions Act 1992 Website: https://www.ontario.ca/laws/statute/92s30

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    This table from pages 83-84 of the Delirium, Dementia, and Depression in Older Adults: Assessment and Care BPG (2016) informs nurse educators of relevant content for designing education sessions for those caring for clients with delirium, dementia and depression.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

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    The RGP of Eastern Ontario is a coordinated network of specialized geriatric services, from hospital to home. Their clinical services, teaching and research are committed to optimizing the health and independence of seniors in the Champlain region. Website: http://www.rgpeo.com/en.aspx

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    At the core of nursing is the therapeutic nurse-client relationship. The College's Therapeutic Nurse-Client Relationship, Revised 2006, practice standard describes the expectations for all nurses in establishing, maintaining and terminating a therapeutic relationship.

    College of Nurses of Ontario. (2006). Therapeutic nurse-client relationship (rev ed.). http://www.cno.org/globalassets/docs/prac/41033_therapeutic.pdf

     

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    This site from Capital District health Authority, Halifax, Nova Scotia includes a vignette showing a daughter recognizing that her mother's behaviour has changed suddenly and therefore is not just related to her dementia. Delirium is described in the video and the site includes other information and resources for delirium.

    Reference: This is not My Mom Website: http://thisisnotmymom.ca/

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    This pocket card produced by the National Initiative for Care of the Elderly (NICE) and Advocacy Centre for the Elderly (ACE) helps practitioners to reach informed consent and determine resident capacity for decision making. 

    National Initiative for Care of the Elderly Website. (n.d.). Tool on capacity and consent: Ontario edition. [PDF] http://www.nicenet.ca/files/NICE_Capacity_and_Consent_tool.pdf

     

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    Appendix E pages 128-130 of the BPG Delirium, Dementia and Depression in Older Adults: Assessment and Care (2016) identifies the major types of dementia and a description of each.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

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    U-FIRST! Is a proven and effective approach to working with people with dementia. Through dialogue and a case-based approach, learners will have more confidence in working with people with responsive behaviours. Training is especially designed for people working in community care, acute care and long-term care. For more information visit www.u-first.ca.  Permission to post obtained from Cathy Conway.

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    The University of Tasmania, Australia, offers a free online course on Understanding Dementia. The course is delivered over 7 week, in order to obtain the most from this course, participants should expect to spend approximately 3 hours per week engaging with the course content and activities. 

    University of Tasmania. (n.d.). Understanding dementia. Retrieved from http://www.utas.edu.au/wicking/understanding-dementia

     

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    The Centre for Effective Practice provides the BPSD Discussion Guide designed to help providers understand, assess, and manage residents in long-term-care homes with behavioural and psychological symptoms of dementia, with a focus on antipsychotic medications.

    Reference: (Use Referencing Guide available at http://ltcprojects.rnao.ca/ltcbpi_general/node/633) Centre for Effective Practice (2016). Use of Antipsychotics in Behavioural and Psychological Symptoms of Dementia (BPSD) Discussion Guide. Retrieved from https://effectivepractice.org/wp-content/uploads/2016/04/UseofAntipsychotics_LTC2016.pdf

    © 2015 Centre for Effective Practice Inc. All Rights Reserved.

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    This is a comprehensive list of the causes of delirium and other mental status changes, that is part of Public Health Ontario’s Urinary Tract Infection (UTI) Program. It clearly describes a variety of other conditions to consider whether a UTI is present.

    Reference: Public Health Ontario. 2016. UTI Program: Causes of delirium and mental status changes. Accessed Mar. 17, 2017. http://www.publichealthontario.ca/en/BrowseByTopic/IPAC/Documents/UTI_Delirium_Mental_Status.pdf  

    © 2017 Ontario Agency for Health Protection and Promotion

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    This learning module, developed by St Joseph’s Healthcare and Halton Seniors Mental Health Outreach Program, is a guide for LTC staff to provide safe and respectful care when a resident is exit-seeking.

    Reference: St Joseph’s Healthcare & Halton Seniors Mental Health Outreach Program (n.d.) Working with a Resident who is Exit-Seeking A learning module for LTC staff. Retrieved from http://brainxchange.ca/Public/Files/Education/Education-Module_Exit-seeking.aspx