Delirium, Dementia and Depression Responsive Behaviours

A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.

Registered Nurses Association of Ontario (2022) Gap Analysis-Delirium, Dementia and Depression in Older Adults . Toronto, ON.

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/

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

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

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

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.

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.

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

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/ 

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

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  

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 (2023). Dementia Factsheets. Retrieved from: https://www.i-caare.ca/factsheets 

©  2023 ICARE

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. 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.

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

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

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

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

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/

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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

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

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

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

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.

This resource from Interior Health, is a pain assessment tool useful for scoring pain levels of people with dementia who are unable to verbally express their pain. It focuses on assessing behaviours and provides a score rating of mild, moderate or severe pain levels.

Retrieved from: https://www.interiorhealth.ca/sites/default/files/PDFS/810310-pain-assessment-advance-dementia-scale.pdf

Warden, V., Hurley, A. & Volicer. L. (2003). Development and psychometric evaluation of the pain assessment in advanced dementia (PAINAD) scale. JAMDA, 4(1), 9 -15. Horgas, A., & Miller, L. (2008). Pain assessment in people with dementia. American Journal of Nursing, 108(7), 62-70.

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/

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

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

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

Reference: adapted from "The patient who is depressed" in Psychiatry in Primary Care by Raymond W. Lam, (CAMH, 2019).

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

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

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

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

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

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.