Life In The Slower Lane

Here is the structured PICO analysis for the twenty-third article you uploaded:

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Full Title (verbatim and exact):

“Clinical pathways for the evidence-based management of behavioural and psychological symptoms of dementia in a residential aged care facility: A rapid review”

Kennedy KJ, Forsythe D, Wagner J, Eckert M

Australasian Journal on Ageing (2021); 40(4):347–355

DOI: https://doi.org/10.1111/ajag.12990

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Type of Article:

Rapid systematic review of guidelines and operational resources

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PICO Analysis:

Population:

• Older people living with dementia in residential aged care facilities (RACFs)
• Focused on those experiencing or at risk of experiencing behavioural and psychological symptoms of dementia (BPSD), including:
  • Aggression, apathy, anxiety, agitation, psychosis, depression, disinhibition, nocturnal disruption, wandering, and vocalisation 

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Intervention:

• Evidence-based clinical guidance or recommendations to inform development of a clinical pathway for BPSD management in RACFs
• Literature synthesised into five risk-based stages of care:
  1. Risk assessment
  2. Prevention (no or low risk)
  3. Watchful waiting (mild-to-moderate risk)
  4. Escalation (high risk)
  5. Pharmacological interventions
• Emphasis on person-centred care, early identification, non-pharmacological strategies, and structured care planning 

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Comparator:

• No direct comparison group (this is a review article), but standard RACF practice prior to implementing pathways serves as implicit comparator
• Aimed to bridge the gap between existing unstructured practices and structured, evidence-informed care

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Outcome:

1. Person-centred outcomes:

• Not directly measured in this review but highlighted as key targets in included guidelines:
  • Reduction in frequency/severity of BPSD
  • Improved quality of life
  • Preservation of autonomy and personal dignity
  • Reduced carer stress and increased family involvement 

2. Process outcomes:

• Intended outcomes of implementing a clinical pathway include:
  • Standardised and timely assessment and care planning
  • Improved documentation and care coordination
  • Reduced inappropriate antipsychotic prescribing
  • Integration of non-pharmacological strategies as first-line approach

3. Health system outcomes:

• Expected benefits (not empirically evaluated in this review) include:
  • Fewer ED transfers and hospitalisations
  • Reduced use of high-risk medications (e.g. antipsychotics)
  • More efficient use of RACF staff resources
  • Better alignment with aged care standards and Royal Commission recommendations

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Summary Conclusion:

This rapid review found that while no existing clinical pathway was identified for BPSD in Australian RACFs, multiple high-quality guidelines and operational resources exist. These consistently recommend a tiered approach prioritising person-centred care, early identification of triggers, and non-pharmacological interventions, with medications reserved for short-term use in high-risk situations. The review provides a foundation for developing a contextualised, evidence-informed clinical pathway to be piloted in Australian RACFs. The proposed model aligns with aged care reform goals and has the potential to improve quality and safety of dementia care.