Abstract
Background. Agitation is a common challenging behavior in dementia with a negative influence on patient’s quality of life and a high caregiver burden. Treatment is often difficult. The Dutch Verenso guideline provides recommendations for psychotropic drug (PD) treatment.
Objective. To explore how physicians decide on PD treatment for agitated behavior in dementia when they fail to manage with guideline prescribing recommendations.
Methods. We conducted five online focus groups with a total of 22 elderly care physicians, five clinical geriatricians and four geriatric psychiatrists, in The Netherlands. The focus groups were thematically analyzed.
Results. We identified six main themes. The first overarching theme (1) ‘not one size fits all’ refers to many physicians stating that there is no PD treatment that works in all cases. The next five themes regard the steps physicians indicate to decide on non-guideline PD treatment for agitated behavior in dementia: (2) ‘analysis of problem and cause’, (3) ‘hypothesis of underlying cause and treatment goal’, (4) ‘considerations regarding drug choice’, (5) ‘trial & error’ and (6) ‘last resort’.
Conclusion. The decision on PD treatment for agitated behavior in dementia outside the guideline prescribing recommendations is not a straight forward process. Physicians first go back to the analysis and try to substantiate and justify medication choices as best they can with a hypothesis of underlying cause, using other guidelines, and choosing PD treatment weighed up to the individual. Hypotheses can be weak due to diagnostic uncertainty which can lead to trying different kinds of PDs.
Objective. To explore how physicians decide on PD treatment for agitated behavior in dementia when they fail to manage with guideline prescribing recommendations.
Methods. We conducted five online focus groups with a total of 22 elderly care physicians, five clinical geriatricians and four geriatric psychiatrists, in The Netherlands. The focus groups were thematically analyzed.
Results. We identified six main themes. The first overarching theme (1) ‘not one size fits all’ refers to many physicians stating that there is no PD treatment that works in all cases. The next five themes regard the steps physicians indicate to decide on non-guideline PD treatment for agitated behavior in dementia: (2) ‘analysis of problem and cause’, (3) ‘hypothesis of underlying cause and treatment goal’, (4) ‘considerations regarding drug choice’, (5) ‘trial & error’ and (6) ‘last resort’.
Conclusion. The decision on PD treatment for agitated behavior in dementia outside the guideline prescribing recommendations is not a straight forward process. Physicians first go back to the analysis and try to substantiate and justify medication choices as best they can with a hypothesis of underlying cause, using other guidelines, and choosing PD treatment weighed up to the individual. Hypotheses can be weak due to diagnostic uncertainty which can lead to trying different kinds of PDs.
| Original language | English |
|---|---|
| Journal | Tijdschrift voor Ouderengeneeskunde |
| Publication status | Published - 23 Nov 2021 |