Review
Efficacy and Feasibility of Nonpharmacological Interventions for Neuropsychiatric Symptoms of Dementia in Long Term Care: A Systematic Review

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Abstract

Background

Nonpharmacological therapies are often recommended as a first-line treatment for neuropsychiatric symptoms (NPS) of dementia in long term care (LTC); however, little is known about which nonpharmacological interventions are most effective for NPS in LTC or the feasibility of interventions, given the availability of resources in typical LTC environments.

Methods

We searched the electronic databases MEDLINE, EMBASE, PsychINFO (1980–2010), the Cochrane Library, and Google Scholar using keywords and medical subject headings for randomized, controlled trials evaluating nonpharmacological interventions for NPS conducted in LTC settings. Change in severity of NPS symptoms was evaluated through the NPS outcomes measures reported in studies. We assessed study quality and described the feasibility of interventions based on various aspects of study design.

Results

A total of 40 studies met inclusion criteria. Sixteen (40%) of 40 included studies reported statistically significant results in favor of nonpharmacological interventions on at least one measure of NPS. These interventions included staff training in NPS management strategies, mental health consultation and treatment planning, exercise, recreational activities, and music therapy or other forms of sensory stimulation. Many of the studies had methodological limitations that placed them at potential risk of bias. Most interventions (n = 30, 75%) required significant resources from services outside of LTC or significant time commitments from LTC nursing staff for implementation.

Conclusions

There are several nonpharmacological interventions that may be effective for NPS in LTC, although there are a limited number of large-scale, high-quality studies in this area. The feasibility of some interventions will be limited in many LTC settings and further research into practical and sustainable interventions for NPS in LTC is required to improve usage of these important treatments.

Section snippets

Search Strategy

We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for conducting systematic reviews to guide the review process.38 We searched the electronic databases Medline (1980–2010) and EMBASE (1980–2010), PsychINFO (1980–2010), and the Cochrane Library, using free text search terms and medical subject headings for potentially relevant articles. We combined terms for dementia, LTC, behavioral symptoms, and nonpharmacological interventions (

Study Selection

The flow of studies through the review process is outlined in Supplementary Figure 1. A total of 4589 citations were identified through searches of electronic databases and 55 references from hand-searches of reference lists for a total of 3922 unique citations. After screening of titles and abstracts, 419 full-text articles were retrieved and reviewed for inclusion criteria with 40 studies meeting inclusion criteria.49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68

Discussion

This review identified that there are several interventions that have been investigated for treatment of NPS in LTC settings, although there are only a few large, high-quality studies in this area. There is some support in the literature for interventions involving training of LTC staff, geriatric mental health consultation, provision of psychosocial activities, or activities involving exercise, music, or other forms of sensory stimulation. The observed benefits of many interventions appeared

Conclusion

Currently there are only a small number of high-quality clinical trials for nonpharmacological interventions for NPSs of dementia in LTC. A variety of different types of interventions have some evidence to support their use. One potential limitation of many nonpharmacological interventions is their potential limited feasibility in many LTC settings. Additional research is also required to determine the effectiveness of nonpharmacological interventions when implemented in routine clinical care

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    This work was supported by Canadian Institutes of Health Research Knowledge Synthesis Grant KRS no. 103345.

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