Quality of dementia clinical guidelines and relevance to the care of older people with comorbidity: evidence from the literature

Figures & data

Table 1 Basic characteristics of the selected guidelines (n=22)

Study	Publication year	Country/region	Intended users	Diagnosis	Treatment
Cantrell et al^Citation23	2012	US	General practitioners/others	Yes	Pharmacological Nonpharmacological
Bavazzano et al^Citation24	2011	Italy	General practitioners/specialists	Yes	Pharmacological Nonpharmacological
Segal-Gidan et al^Citation25	2011	US	General practitioners	Yes	Pharmacological Nonpharmacological
Rossy et al^Citation26	2010	Canada	General practitioners/others	Yes	Pharmacological Nonpharmacological
Hort et al^Citation27	2010	Europe	Specialists	Yes	Pharmacological Nonpharmacological
American Geriatrics Society^Citation28	2010	US	General practitioners/specialists/others	No	Pharmacological Nonpharmacological
Toward Optimized Practice Program^Citation29	2008	Canada	Specialists	Yes	Pharmacological Nonpharmacological
Hogan et al^Citation30	2008	Canada	General practitioners/others	Yes	Pharmacological Nonpharmacological
Hogan et al^Citation31	2008	Canada	General practitioners	No	Pharmacological Nonpharmacological
Hermann and Gauthier^Citation32	2008	Canada	Specialists/others	Yes	Pharmacological
Qaseem et al^Citation33	2008	US	Specialists	No	Pharmacological
Capezuti et al^Citation34	2008	US	General practitioners/specialists/others	No	Pharmacological Nonpharmacological
California Workgroup on Guidelines for Alzheimer’s Disease Management^Citation35	2008	US	General practitioners	Yes	Pharmacological Nonpharmacological
National Collaborating Centre for Mental Health^Citation36	2007	UK	General practitioners/others	Yes	Pharmacological Nonpharmacological
Rabins et al^Citation37	2007	US	Specialists/others	No	Pharmacological Nonpharmacological
Tilly et al^Citation38	2007	US	General practitioners/others	No	Pharmacological Nonpharmacological
Fillitt et al^Citation39	2006	US	General practitioners/others	Yes	Pharmacological
Scottish Intercollegiate Guidelines Network^Citation40	2006	Scotland	General practitioners/specialists	Yes	Pharmacological Nonpharmacological
Alexopoulos et al^Citation41	2005	US	General practitioners/specialists/others	No	Pharmacological Nonpharmacological
Cummings et al^Citation42	2002	US	General practitioners	Yes	Pharmacological Nonpharmacological
Patterson et al^Citation43	2001	Canada	General practitioners	Yes	Nonpharmacological
Doody et al^Citation44	2001	US	Specialists/others	No	Pharmacological

Figure 1 Flowchart of the clinical guidelines (CGs).

Table 2 Individual standardized Appraisal of Guidelines for Research and Evaluation (AGREE) domain scores (%) for the guidelines studied, and mean and standard deviation (SD) for each domain

Study	Year	Country/region	Scope and purpose	Stakeholder involvement	Rigor of development	Clarity of presentation	Applicability	Editorial independence
Cantrell et al^Citation23	2012	US	75%	77%	65%	69%	52%	100%
Bavazzano et al^Citation24	2011	Italy	72%	62%	52%	81%	44%	100%
Segal-Gidan et al^Citation25	2011	US	83%	55%	44%	61%	50%	50%
Rossy et al^Citation26	2010	Canada	92%	87%	93%	97%	67%	79%
Hort et al^Citation27	2010	Europe	81%	77%	49%	83%	23%	50%
American Geriatrics Society^Citation28	2010	US	42%	12%	7%	47%	2%	0%
Toward Optimized Practice Program^Citation29	2008	Canada	39%	21%	17%	44%	15%	0%
Hogan et al^Citation30	2008	Canada	64%	83%	46%	69%	37%	75%
Hogan et al^Citation31	2008	Canada	67%	67%	40%	83%	46%	71%
Hermann and Gauthier^Citation32	2008	Canada	89%	73%	58%	92%	42%	8%
Qaseem et al^Citation33	2008	US	78%	69%	73%	81%	56%	79%
Capezuti et al^Citation34	2008	US	78%	83%	65%	58%	62%	42%
California Workgroup on Guidelines for Alzheimer’s Disease Management^Citation35	2008	US	86%	71%	32%	86%	40%	0%
National Collaborating Centre for Mental Health^Citation36	2007	UK	94%	94%	94%	69%	83%	71%
Rabins et al^Citation37	2007	US	78%	88%	68%	89%	46%	96%
Tilly et al^Citation38	2007	US	81%	50%	48%	67%	21%	17%
Fillitt et al^Citation39	2006	US	78%	50%	23%	67%	38%	58%
Scottish Intercollegiate Guidelines Network^Citation40	2006	Scotland	78%	85%	83%	100%	88%	54%
Alexopoulos et al^Citation41	2005	US	69%	54%	61%	58%	27%	0%
Cummings et al^Citation42	2002	US	67%	60%	32%	78%	63%	46%
Patterson et al^Citation43	2001	Canada	92%	67%	58%	75%	71%	96%
Doody et al^Citation44	2001	US	89%	81%	73%	89%	48%	67%
Mean (SD)			75% (14%)	67% (20%)	54% (23%)	75% (15%)	45% (21%)	49% (34%)

Table 3 Clinical guidelines (CGs) and treatments for older patients

	Total CGs n (%)
Issues addressed
Guideline addressed treatment for older patients	20 (91%)
Guideline addressed treatment for older patients divided in different classes of age	5 (23%)
Guideline addressed treatment for patients with multiple comorbid conditions	13 (60%)
Guideline addressed treatment for older patients with multiple comorbid conditions	6 (27%)
Quality of evidence
Quality of evidence discussed for older patients	18 (82%)
Quality of evidence discussed for patients with multiple comorbid conditions	7 (32%)
Quality of evidence discussed for older patients with comorbid conditions	7 (32%)
Recommendations
Specific recommendations for patients with one comorbid condition	13 (60%)
Specific recommendations for patients with several comorbid conditions	7 (32%)
Burden of treatment
Time needed to treat to benefit from treatment in the context of life expectancy discussed	14 (64%)
Guideline discussed burden of comprehensive treatment on patients or caregivers	18 (82%)
Guideline discussed patients’ financial burden	10 (45%)
Guideline discussed patients’ quality of life	22 (100%)
Patient preferences
Guideline discussed patients’ preferences	16 (73%)
Guideline discussed patients’ preferences for end-of-life treatment	11 (50%)

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