title: Individualized guidelines for the management of aggression in dementia - Part 2: appraisal of current guidelines.
abstract: BACKGROUND
  Individualized guidelines have the potential to offer clinicians assistance in decision-making at the point of consultation to improve health outcomes for patients. This project aims to develop individualized guidelines for the management of aggression in dementia. At an earlier stage, we developed a map of concepts to consider when managing aggression. The purpose of the current study is to appraise paper-based guidelines for their representation of these concepts.
  
  
  METHODS
  Two reviewers used a four-point scale (absent, weak, moderate, strong) to rate the guidelines on their representation of concepts relating to the patient, the aggression and dementia disorder, the treatment, and the guidelines themselves. Consensus was reached on inconsistent scores.
  
  
  RESULTS
  Sixteen guidelines published since 2005 were evaluated for their representation of 13 key concepts. Pharmacological and non-pharmacological interventions were strongly represented overall in the guidelines, in conjunction with a consideration of the individual characteristics of the patients and their environment. Recommendations based on the presentation of the aggressive symptoms, goals of treatment, and theory of the cause of the aggression were moderately represented in the guidelines. Recommendations for the principles of restraint use and emergency treatment, as well as a consideration of the personal history of the patient, were poorly represented. Only 6 of 16 guidelines gave details of the expected review.
  
  
  CONCLUSIONS
  Concepts important to the management of aggression in dementia are missing in the majority of published guidelines on dementia. This limits the ability of these tools to guide clinical practice effectively.
authors.affiliation: Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia. victor.vickland@unsw.edu.au
authors.forename: Victor
authors.initials: V
authors.lastname: Vickland
authors.forename: Natalie
authors.initials: N
authors.lastname: Chilko
authors.forename: Brian
authors.initials: B
authors.lastname: Draper
authors.forename: Lee-Fay
authors.initials: LF
authors.lastname: Low
authors.forename: Daniel
authors.initials: D
authors.lastname: O'Connor
authors.forename: Henry
authors.initials: H
authors.lastname: Brodaty
mesh_terms: D000368:Aged; D000374:Aggression / Q000523:psychology*; D003704:Dementia / Q000150:complications / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy; D006801:Humans; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D012149:Restraint, Physical