Development of the Canadian Coalition for Seniors' Mental Health Canadian Guidelines on the Assessment and Management of Behavioural and Psychological Symptoms of Dementia
Bibliographic record
Abstract
Abstract Background Behavioural and psychological symptoms in dementia (BPSD) are common, can be distressing for persons living with dementia (PLWD), and challenging for caregivers and clinicians. There are few updated clinical practice guidelines available to assist clinicians with the assessment and management of BPSD, including deprescribing of medications. The Canadian Coalition for Seniors’ Mental Health (CCSMH) developed Canadian clinical practice guidelines on the assessment and management of BPSD to address these needs. Methods We used the Guideline International Network process for development of the BPSD guidelines. A multidisciplinary guideline panel was formed including representatives from geriatric psychiatry, geriatric medicine, family medicine, nursing, pharmacy, and psychology. Surveys identified priority topic areas for the guidelines. A review of existing guidelines, systematic reviews and primary evidence reviews was undertaken to identify evidence to create the guideline recommendations. The guideline panel members framed guideline questions using the PICO format (patient, intervention, comparator, and outcome). Guideline recommendations were created using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) tool and assigned a strength of recommendation (strong or conditional) and quality of evidence (high, moderate, low, and very low). The final guideline recommendations were voted on by the guideline panel with consensus considered to be 80% agreement. Results The guideline panel met a total of 14 times. A total of 74 recommendations reached consensus and were included in the guideline. These included recommendations on general principles of BPSD assessment and management, BPSD diagnosis, detection, and pharmacological and non‐pharmacological management of BPSD syndromes. The following topic areas and recommendations per topic were: general principles of BPSD assessment and management (n = 11), agitation (n = 30), psychosis (n = 5), depression and depressive symptoms (n = 13), anxiety (n = 6), sexual expressions with associated risk (n = 4), and deprescribing (n = 5). Conclusions The CCSMH Canadian Guidelines on the Assessment and Management of BPSD provide healthcare providers with recommendations based on current evidence from a Canadian context. These guidelines will help inform care for the growing number of people living with dementia who may be affected by BPSD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.050 | 0.121 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.003 | 0.006 |
| Bibliometrics | 0.017 | 0.012 |
| Science and technology studies | 0.005 | 0.003 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.010 | 0.005 |
| Research integrity | 0.006 | 0.009 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".