Document Type : Original Article


1 Student Research Committee, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

2 Mental Health Research Center, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences (IUMS), Tehran, Iran

3 Department of Neurology, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran


BACKGROUND: Advanced stages of dementia interfere with elderly self‑care. Consequently, they
need caregivers who take responsibility for their care in the long‑term. Restrictions to the caregiver’s
access to information, resources, and organizational support have created problems in their caregiver
role, which is why the World Health Organization (WHO) emphasizes caring for caregivers by providing
evidence‑based information and training programs. As there is no clinical practice guideline for home
care in the Islamic Republic of Iran, this study aims to develop a home health care guideline for the
elderly with dementia.
MATERIALS AND METHODS: The ADAPTE process provided by the Guidelines International
Network was considered as the basis. In order to identify the care needs of Iranian patients with
dementia, semi‑structured interviews were added to this guideline.
DISCUSSION: The identification and implementation of the perspectives of patients and caregivers
during the process of guidelines adaptation increase the applicability of the guidelines. Improved
quality of life for the patients in their place of residence is one of the expected consequences of this
guideline’s implementation. The developed guidelines will be used at home health care centers, and
dementia and Alzheimer’s associations in Iran.


1. WHO. Global Action Plan on the Public Health Response to
Dementia 2017–2025. Geneva: World Health Organization; 2017.
2. ADI. From plan to impact progress towards targets of the global
action plan on dementia. London: 2018. Available from: https://
3. WHO. The Epidemiology and Impact of Dementia: Current State
and Future Trends. Geneva: World Health Organization; 2015.
4. Sharifi F, Fakhrzadeh H, Varmaghani M, Arzaghi SM,
Alizadeh Khoei M, Farzadfar F, et al. Prevalence of dementia and
associated factors among older adults in Iran: National elderly
health survey (NEHS). Arch Iran Med 2016;19:838-44.
5. Touhy TA, Jett K. Ebersole and Hess’ Gerontological Nursing &
Healthy Aging. 5th ed. China: Elsevier; 2018.
6. Heydari M, Razban F, Mirzaei T, Heidari S. The effect of problem
oriented coping strategies training on quality of life of family
caregivers of elderly with Alzheimer. Asian J Nurs Educ Res
7. AbdollahpourI, Noroozian M, Nedjat S, MajdzadehR. Psychiatric
symptoms in patients with dementia: Prevalence and their
relationship with caregiver burden. Iran J Epidemiol 2011;7:51-9.
8. Baxter S, Beckwith SK, Clark D, Cleary J, Falzon D, Glaziou P,
et al. Global Atlas of Palliative Care at the End of Life. London:
Worldwide Palliative Care Alliance; 2014.
9. Andrade AM, Silva KL, Seixas CT, Braga PP. Nursing practice
in home care: An integrative literature review. Rev Bras Enferm
10. SafdariR, AlizadehM, MohamadiazarM, Sharifi F, Fakhrzadeh H.
Comprative study of home care program in Iran with other
developed countries. Iran J Diabetes Lipid Disord 2014;13:439-46.11. Kredo T, Bernhardsson S, Machingaidze S, Young T, Louw Q,
Ochodo E, et al. Guide to clinical practice guidelines: The current
state of play. Int J Qual Health Care 2016;28:mzv115.
12. Attia A. Adaptation of international evidence based clinical
practice guidelines: The ADAPTE process. Middle East Fertil Soc
J 2013;18:123-6.
13. Nezamzadeh M, Khadem AlHusseini SM, Mokhtari Noori J,
Ebadi A. Designing evidence-based nursing care guidelines in
patients with angina pectoris. Iran J Crit Care Nurs 2012;4:169-76.
14. Bahramnezhad F, Cheraghi MA. Realization of clinical guidelines
in providing health services. Hayat 2015;21:1-4.
15. Yamada J, Shorkey A, Barwick M, Widger K, Stevens B. The
effectiveness of toolkits as knowledge translation strategies for
integrating evidence into clinical care: A systematic review. BMJ
Open 2015;5:e006808. doi: 10.1136/bmjopen-2014-006808.
16. The ADAPTE collaboration. The ADAPTE process: Resource
Toolkit for guideline adaptation. 2, editor 2009.
17. The AGREE Collaboration. Development and validation of an
international appraisal instrument for assessing the quality of
clinical practice guidelines: The AGREE project. Qual Saf Health
Care 2003;12:18-23.
18. Rashidian A, YousefiNooraie R. Development of a Farsi
translation of the AGREE instrument, and the effects of group
discussion on improving the reliability of the scores. J Eval Clin
Pract 2012;18:676-81.
19. Jiao X-F, Li H-L, Cheng L, Zhang C, Yang C-S, Han J, et al.
Methodological quality of clinical practice guidelines for genetic
testing in children: A systematic assessment using the appraisal
of guidelines for research and evaluation II instrument. Medicine
20. Durepos P, Wickson-Griffiths A, Hazzan AA, Kaasalainen S,
Vastis V, Battistella L, et al. Assessing palliative care content in
dementia care guidelines: A systematic review. J Pain Symptom
Manag 2017;10:804-13.
21. Roddis JK, Liversedge HL, RyderI, Woodhouse M. Incorporating
the patient experience into clinical guidelines: Recommendations
for researchers and guideline developers. BMJ Evid Based Med
22. Omranifard V, Haghighizadeh E, Akoochakian S. Depression in
main caregivers of dementia patients: Prevalence and predictors.
Adv Biomed Res 2018;7:34. doi: 10.4103/2277-9175.225924.
23. Cooper C, Manela M, Katona C, Livingston G. Screening for
elder abuse in dementia in the LASER-AD study: Prevalence,
correlates and validation of instruments. Int J Geriatr Psychiatry
24. Goodarzi N, Rahgoi A, Mohammadi Shahboulaghi F, Biglarian A.
Correlation between family function and anxiety in family carers
of elderly with dementia. Iran J Psychiatr Nurs 2018;6:1-9.
25. Salamizadeh A, Mirzaei T, Ravari A. The impact of spiritual care
education on the self-efficacy of the family caregivers of elderly
people with Alzheimer’s disease. Int J Community Based Nurs
Midwifery 2017;5:231-8.
26. Eliopous C. Gerontological Nursing. 9th ed. China: Wolters
Kluwer; 2018.
27. Kim JW, Byun MS, Sohn BK, Yi D, Seo EH, Choe YM, et al. Clinical
dementia rating orientation score as an excellent predictor of the
progression to Alzheimer’s disease in mild cognitive impairment.
Psychiatry Investig 2017;14:420-6.
28. Jhang KM, Chang MC, Lo TY, Lin CW, Wang WF, Wu HH.
Using the apriori algorithm to classify the care needs of patients
with different types of dementia. Patient Prefer Adherence
29. Khanassov V, Vedel I. Family physician-case manager
collaboration and needs of patients with dementia and their
caregivers: A systematic mixed studies review. Ann Fam Med
30. Graneheim UH, Lindgren BM, Lundman B. Methodological
challenges in qualitative content analysis: A discussion paper.
Nurse Educ Today 2017;56:29-34.
31. Castleberry A, Nolen A. Thematic analysis of qualitative
research data: Is it as easy as it sounds? Curr Pharm Teach Learn
32. Holloway I, Galvin K. Qualitative Research in Nursing and
Healthcare. 4th ed. UK: Wiley Blackwell; 2017.
33. Fitch K, Bernstein SJ, Aguilar MD, Burnand B, LaCalle JR,
Lázaro P, et al. The RAND/UCLA Appropriateness Method User’s
Manual. Santa Monica: RAND; 2001.
34. Berian JR, Baker TL, Rosenthal RA, Coleman J, Finlayson E,
Katlic MR, et al. Application of the RAND-UCLA appropriateness
methodology to a large multidisciplinary stakeholder group
evaluating the validity and feasibility of patient-centered
standards in geriatric surgery. Health Serv Res 2018;53:3350-72.
35. Ministry-of-Health. Clinical practice guideline adaptation model
in I.R.Iran. Iran 2010.
36. Brouwers MC, Kerkvliet K, Spithoff K, AGREE Next Steps
Consortium. The AGREE reporting checklist: A tool to improve
reporting of clinical practice guidelines. BMJ (Clinical research
ed) 2016;352:i1152. doi: 10.1136/bmj.i1152.
37. Polit DF, Beck CT. Nursing research generating and assessing
evidence for nursing evidence for nursing practice 2017.