Background and Objectives: Several systematic reviews exist that examine the efficacy of educational interventions in randomized controlled trials (RCTs) designed to improve formal caregivers' knowledge and skills and/or the outcomes of persons living with dementia. The aim of this article is to summarize existing systematic reviews to assess the effectiveness of educational interventions tested...
(Edited publisher abstract)
Background and Objectives: Several systematic reviews exist that examine the efficacy of educational interventions in randomized controlled trials (RCTs) designed to improve formal caregivers' knowledge and skills and/or the outcomes of persons living with dementia. The aim of this article is to summarize existing systematic reviews to assess the effectiveness of educational interventions tested in RCTs and directed at formal caregivers. Research Design and Methods: Smith et al.'s methodology guided this systematic review of systematic reviews. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2) for quality appraisals. Reviews were included if they contained interventions with an RCT design that focused on changing staff behavior and/or practice toward persons living with dementia, in any setting and for any health care discipline. Results: We identified six systematic reviews, one rated as high-quality on the AMSTAR 2. Most interventions were directed at nursing staff, in long-term care facilities, focused on agitation, and were atheoretical. There is insufficient evidence to guide implementation of currently tested interventions; however, training in communication skills, person-centered care, and dementia-care mapping with supervision show promise for improving agitation. Discussion and Implications: There's a critical need for additional research with well-designed RCTs, and clear reporting of protocols and findings to inform the field on how best to train and support the workforce. Although there is no conclusive evidence on what interventions are most effective, it could be argued that providing training using interventions with modest evidence of impact is better than no training at all until the evidence base is strengthened.
(Edited publisher abstract)
Health and Social Care in the Community, 30(4), 2022, pp.1315-1324.
Publisher:
Wiley
The objectives of the study were (a) to compare self-reported Quality of Life (QoL) in a 24-month follow-up of people with dementia attending day care designed for people with dementia (day-care group, DC) with people with dementia who did not attend day care (control group, CG) and (b) to explore factors associated with QoL. A quasi-experimental design with a 24-month follow-up period was used...
(Edited publisher abstract)
The objectives of the study were (a) to compare self-reported Quality of Life (QoL) in a 24-month follow-up of people with dementia attending day care designed for people with dementia (day-care group, DC) with people with dementia who did not attend day care (control group, CG) and (b) to explore factors associated with QoL. A quasi-experimental design with a 24-month follow-up period was used. The DC group included 181 participants recruited from 53 day-care services. The CG included 76 participants recruited from 19 municipalities with no available day care designed for people with dementia. The sample covered the four health regions of Norway and inclusion period lasted from December 2013 to July 2015. The Quality of Life in Alzheimer's Disease (QoL-AD) scale was used as the outcome measure. The differences in QoL between groups and the associations between participant characteristics and QoL, such as depressive symptoms and functional dependency, were examined using a linear mixed model. In the multiple model, the overall trend in QoL did not differ significantly between the DC and CG. However, the DC group exhibited significantly higher self-reported QoL than the CG at all time points (p < 0.001 at T0, p = 0.018 at T12, and p = 0.006 at T24). Participants with shallow or no awareness who attended day care had significantly higher scores on QoL-AD than persons with full awareness (p = 0.017). More depressive symptoms (p < 0.001) and higher functional dependency (p < 0.001) were associated with lower self-reported QoL. The study revealed higher scores of self-reported QoL among people attending day care compared with those who did not attend, showing that day care might have positive impact on the lives of people with dementia.
(Edited publisher abstract)
Subject terms:
dementia, quality of life, evaluation, day services, day centres, outcomes, comparative studies;
Animal-assisted interventions (AAIs) are non-pharmacological, cost-effective interventions developed to improve outcomes in patients with dementia; however, the effects remain inconclusive. The purpose of this study was to analyze the efficacy of AAIs for people with dementia. A systematic review and meta-analysis was performed of English-language literature published from January 1, 2001...
(Edited publisher abstract)
Animal-assisted interventions (AAIs) are non-pharmacological, cost-effective interventions developed to improve outcomes in patients with dementia; however, the effects remain inconclusive. The purpose of this study was to analyze the efficacy of AAIs for people with dementia. A systematic review and meta-analysis was performed of English-language literature published from January 1, 2001, to July 3,2021, and indexed in the following databases: CINAHL, EMBASE, MEDLINE, PubMed, Web of Science, Cochrane, and PsycINFO. Intervention groups were people with dementia who received AAIs. Study quality was assessed using the Joanna Briggs Institute tool. Among 10 included studies, significant differences in depression levels were identified between the intervention and control groups (p < 0.001). No significant differences in cognitive function, neuropsychiatric syndrome, or independence in activities of daily living were observed between groups. Future research remains necessary to examine the effects of AAIs on depression during different stages of dementia. AAIs therapists may collaborate with healthcare workers to improve AAIs benefits.
(Edited publisher abstract)
Purpose: There is growing interest in and evidence for the benefits of connecting with nature for people living with dementia, sometimes known as “green care”, including reduced stress, improved sleeping and even enhanced cognition. However, many people living with dementia are denied such opportunities, often because of practitioner perceptions of risk and poor design of outdoor spaces...
(Edited publisher abstract)
Purpose: There is growing interest in and evidence for the benefits of connecting with nature for people living with dementia, sometimes known as “green care”, including reduced stress, improved sleeping and even enhanced cognition. However, many people living with dementia are denied such opportunities, often because of practitioner perceptions of risk and poor design of outdoor spaces. This paper reports on the evaluation of a project that worked with national providers to give people living with dementia opportunities and support to access the natural environment. Design/methodology/approach: The evaluation adopted a mixed-methods approach, using a combination of bespoke and commonly used tools and in-depth case study work to identify the facilitators and challenges to delivering the project and explore the experiences of activity participants. Findings: Qualitative measures indicated a significant improvement in mental well-being for participants with dementia and family carers following attendance at activity sessions. Research interviews indicated that participants enjoyed activities based on connecting with nature. Being outdoors was a major factor in the experience, along with taking part in activities that were meaningful and opportunities for social interaction. Originality/value: This paper provides evidence for the benefits of connecting with nature for people living with dementia. This paper concludes that access to the outdoors is not a luxury, it is a basic human right and one which has become increasingly important in light of restrictions that have emerged as a result of the COVID19 pandemic.
(Edited publisher abstract)
Subject terms:
dementia, environment, leisure activities, human rights, activities of daily living, evaluation, wellbeing, outcomes;
Journal of the American Medical Directors Association, early cite March 2022,
Publisher:
Elsevier (for the American Medical Directors Association)
...and 130 residents with dementia). Methods: The key outcomes were the well-being and quality of life (QoL) of residents with dementia and the attitudes and knowledge of nursing home staff. Results: There were significant benefits in well-being (t = 2.76, P = .007) and engagement in positive activities (t = 2.34, P = .02) for residents with dementia and in attitudes (t = 3.49, P = .001), including hope
(Edited publisher abstract)
Objective: Digital approaches to delivering person-centered care training to nursing home staff have the potential to enable widespread affordable implementation, but there is very limited evidence and no randomized controlled trials (RCTs) evaluating digital training in the nursing home setting. The objective was to evaluate a digital person-centered care training intervention in a robust RCT. Design: the researchers conducted a 2-month cluster RCT in 16 nursing homes in the United Kingdom, randomized equally to receive a digitally adapted version of the WHELD person-centered care home training program with virtual coaching compared to the digital training program alone. Setting and Participants: The study was conducted in UK nursing homes. There were 175 participants (45 nursing home staff and 130 residents with dementia). Methods: The key outcomes were the well-being and quality of life (QoL) of residents with dementia and the attitudes and knowledge of nursing home staff. Results: There were significant benefits in well-being (t = 2.76, P = .007) and engagement in positive activities (t = 2.34, P = .02) for residents with dementia and in attitudes (t = 3.49, P = .001), including hope (t = 2.62, P = .013) and personhood (t = 2.26, P = .029), for staff in the group receiving digital eWHELD with virtual coaching compared to the group receiving digital learning alone. There was no improvement in staff knowledge about dementia. Conclusion and Implications: The study provides encouraging initial clinical trial evidence that a digital version of the WHELD program supported by virtual coaching confers significant benefits for care staff and residents with dementia. Evidence-based digital interventions with remote coaching may also have particular utility in supporting institutional recovery of nursing homes from the COVID-19 pandemic.
(Edited publisher abstract)
Subject terms:
randomised controlled trials, person-centred care, nursing homes, training, evaluation, digital technology, outcomes;
International Journal of Geriatric Psychiatry, 37(1), 2022, pp.1-13.
Publisher:
Wiley
Objectives: Research has found that music-based interventions can decrease behavioral and psychological symptoms of dementia or behaviors that challenge (BPSD/BtC). However, how to effectively implement these interventions is unclear. This study synthesizes available evidence regarding implementation strategies and outcomes of music-based interventions for people with dementia at residential long...
(Edited publisher abstract)
Objectives: Research has found that music-based interventions can decrease behavioral and psychological symptoms of dementia or behaviors that challenge (BPSD/BtC). However, how to effectively implement these interventions is unclear. This study synthesizes available evidence regarding implementation strategies and outcomes of music-based interventions for people with dementia at residential long-term care facilities. Methods: Study registered with PROSPERO (registration number: CRD42020194354). The researchers searched the following databases: PsychInfo, PubMed, MEDLINE, CINAHL, and The Cochrane Library. Inclusion criteria included articles targeting music-based interventions conducted for people with dementia, studies conducted in residential long-term care facilities, and articles that reported implementation strategies and outcomes of the intervention. Results: Of the included eight studies, half were studies of music therapy and the other half were on individualized music. 49 implementation strategies were reported. The most frequently reported category of strategies was planning (34.7%), followed by education (24.5%), quality management (24.5%), restructuring (12.2%), and finance (4.1%). No strategies under the category of attending to the policy context were reported. The most frequently reported implementation outcomes were appropriateness (27.3%), followed by adoption (22.7%), fidelity (22.7%), acceptability (9.1%), sustainability (9.1%), and cost (9.1%). No studies measured feasibility or penetration. Conclusions: Although various effective implementation strategies were identified, this study was unable to examine the effectiveness of individual implementation strategies due to the designs of the selected studies. Less attention has been paid to strategies that aim at structural changes of intervention delivery systems. Future studies should investigate facilitators and barriers of implementing music-based interventions especially focusing on structural aspects.
(Edited publisher abstract)
Subject terms:
systematic reviews, music therapy, music, dementia, long term care, policy implementation, challenging behaviour, residential care, outcomes;
International Journal of Nursing Studies, early cite January 2022,
Publisher:
Elsevier
Background: Prevalence of neuropsychiatric symptoms amongst people living with dementia in residential aged care is high. Their presence is associated with poorer quality of life for residents and higher burden of care for staff. Existing reviews have not focused on the evaluation of efficacy of non-pharmacological interventions in specific population settings (community vs. residential aged care...
(Edited publisher abstract)
Background: Prevalence of neuropsychiatric symptoms amongst people living with dementia in residential aged care is high. Their presence is associated with poorer quality of life for residents and higher burden of care for staff. Existing reviews have not focused on the evaluation of efficacy of non-pharmacological interventions in specific population settings (community vs. residential aged care). Objectives: To determine the efficacy of non-pharmacological interventions to manage neuropsychiatric symptoms of dementia in residential aged care settings. Design: An umbrella review was conducted. Data sources: PubMed/Medline, Embase, Cochrane Library and Web of Science were searched for eligible reviews in December 2019, February 2020 and June 2021. Methods: Two authors independently screened titles and abstracts, and assessed full-text reviews for eligibility. The quality of reviews was appraised with ‘AMSTAR-2: A Measurement tool to assess systematic reviews’. Narrative summaries grouped findings by intervention domains. Results: From 1362 systematic reviews identified, 26 met the inclusion criteria. Of these, 10 focused on person tailored interventions, six on sensory stimulation interventions, three on environmental interventions, three on exercise interventions, and four on multiple intervention types. Quality ratings identified reviews to be of mostly moderate quality (73%). The majority or reviews reported positive results but not all were statistically significant. Tailored interventions that included music and social elements appeared to be most beneficial for depressive symptoms and mood. Furthermore, outcome measures and intervention protocols were highly heterogeneous across interventions. Conclusions: The findings of this umbrella review suggest that combining different types of interventions and tailoring them to the personal experiences of the resident is recommended. A more standardised approach for outcome measures used is vital to assess efficacy and allow comparison of future non-pharmacological interventions.
(Edited publisher abstract)
Subject terms:
systematic reviews, literature reviews, intervention, dementia, residential care, nursing homes, care homes, environmental factors, physical exercise, outcomes;
International Journal of Geriatric Psychiatry, 37(2), 2022,
Publisher:
Wiley
Objectives: To describe and explain the outcomes of community dementia friendly initiatives (DFIs) for people with dementia and their caregivers to inform the development and tailoring of DFIs. Methods: Literature searches on DFIs were performed through two systematic online database searches of PubMed, Embase, ASSIA, CINAHL and Google scholar. Papers were only included if they evaluated outcomes...
(Edited publisher abstract)
Objectives: To describe and explain the outcomes of community dementia friendly initiatives (DFIs) for people with dementia and their caregivers to inform the development and tailoring of DFIs. Methods: Literature searches on DFIs were performed through two systematic online database searches of PubMed, Embase, ASSIA, CINAHL and Google scholar. Papers were only included if they evaluated outcomes using empirical data from people with dementia or caregivers. Data collection and analysis were guided by the categorization in the DEM-FACT taxonomy and RAMESES guidelines for realist reviews. Results: Of 7154 records identified, 22 papers were included with qualitative, mixed method and quantitative study designs. The synthesis led to a description of programme theories addressing caring, stimulating and activating communities. Outcomes for people with dementia and caregivers included having contact with others, enjoyment and decrease of stress and, lastly, support. This synthesis also indicated how people with dementia participated in a specific role in DFIs, such as patient, team member or active citizen. Conclusions: DFIs generate different outcomes for people with dementia and caregivers, depending on the kind of initiative and the specific role for people with dementia. These findings could be a catalyst for initiation and further development of DFIs in a dementia friendly community (DFC). This draws attention to the multiple aspects of DFCs and supports reflection on their essential principles.
(Edited publisher abstract)
Subject terms:
person-centred care, community care, dementia, carers, literature reviews, outcomes, communities;
Dementia: the International Journal of Social Research and Practice, 21(2), 2022, pp.618-647.
Publisher:
Sage
There is a wealth of literature investigating the role of family involvement within care homes following placement of a relative with dementia. This review summarises how family involvement is measured and aims to address two questions: (1) which interventions concerning family involvement have been evaluated? And (2) does family involvement within care homes have a positive effect...
(Edited publisher abstract)
There is a wealth of literature investigating the role of family involvement within care homes following placement of a relative with dementia. This review summarises how family involvement is measured and aims to address two questions: (1) which interventions concerning family involvement have been evaluated? And (2) does family involvement within care homes have a positive effect on a resident’s quality of life and behavioural and psychological symptoms of dementia? After searching and screening on the three major databases PsycINFO, MEDLINE and CINAHL Plus for papers published between January 2005 and May 2021, 22 papers were included for synthesis and appraisal due to their relevance to family involvement interventions and or family involvement with resident outcomes. Results show that in 11 interventions designed to enhance at least one type of family involvement, most found positive changes in communication and family–staff relationships. Improvement in resident behavioural and psychological symptoms of dementia was reported in two randomised controlled trials promoting partnership. Visit frequency was associated with a reduction of behavioural and psychological symptoms of dementia for residents with moderate dementia. Family involvement was related to positive quality of life benefits for residents. Contrasting results and methodological weaknesses in some studies made definitive conclusions difficult. Few interventions to specifically promote family involvement within care homes following placement of a relative with dementia have been evaluated. Many proposals for further research made over a decade ago by Gaugler (2005) have yet to be extensively pursued. Uncertainty remains about how best to facilitate an optimum level and type of family involvement to ensure significant quality of life and behavioural and psychological symptoms of dementia benefits for residents with dementia.
(Edited publisher abstract)
Subject terms:
dementia, systematic reviews, intervention, care homes, user participation, participation, outcomes, quality of life, nursing homes, family relations;
Objectives: To assess the efficacy and acceptability of remotely delivered interventions aiming to reduce burden and improve mood and quality of life of informal caregivers of people with dementia. Search methods: The researchers searched the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group, MEDLINE, Embase and four other databases, as well as two international trials...
(Edited publisher abstract)
Objectives: To assess the efficacy and acceptability of remotely delivered interventions aiming to reduce burden and improve mood and quality of life of informal caregivers of people with dementia. Search methods: The researchers searched the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group, MEDLINE, Embase and four other databases, as well as two international trials registries, on 10 April 2020. The researchers also examined the bibliographies of relevant review papers and published trials. Selection criteria: This study included only randomised controlled trials that assessed the remote delivery of structured interventions for informal caregivers who were providing care for people with dementia living at home. Caregivers had to be unpaid adults (relatives or members of the person's community). The interventions could be delivered using printed materials, the telephone, the Internet or a mixture of these, but could not involve any face‐to‐face contact with professionals. This study categorised intervention components as information, training or support. Information interventions included two key elements: (i) they provided standardised information, and (ii) the caregiver played a passive role. Support interventions promoted interaction with other people (professionals or peers). Training interventions trained caregivers in practical skills to manage care. This study excluded interventions that were primarily individual psychotherapy. The primary outcomes were caregiver burden, mood, health‐related quality of life and dropout for any reason. Secondary outcomes were caregiver knowledge and skills, use of health and social care resources, admission of the person with dementia to institutional care, and quality of life of the person with dementia. Data collection and analysis: Study selection, data extraction and assessment of the risk of bias in included studies were done independently by two review authors. This study used the Template for Intervention Description and Replication (TIDieR) to describe the interventions. This study conducted meta‐analyses using a random‐effects model to derive estimates of effect size. This study used GRADE methods to describe the degree of certainty about effect estimates. Main results: This study included 26 studies in this review (2367 participants). This study compared (1) interventions involving training, support or both, with or without information (experimental interventions) with usual treatment, waiting list or attention control (12 studies, 944 participants); and (2) the same experimental interventions with provision of information alone (14 studies, 1423 participants). This study downgraded evidence for study limitations and, for some outcomes, for inconsistency between studies. There was a frequent risk of bias from self‐rating of subjective outcomes by participants who were not blind to the intervention. Randomisation methods were not always well‐reported and there was potential for attrition bias in some studies. Therefore, all evidence was of moderate or low certainty. In the comparison of experimental interventions with usual treatment, waiting list or attention control, this study found that the experimental interventions probably have little or no effect on caregiver burden (nine studies, 597 participants; standardised mean difference (SMD) ‐0.06, 95% confidence interval (CI) ‐0.35 to 0.23); depressive symptoms (eight studies, 638 participants; SMD ‐0.05, 95% CI ‐0.22 to 0.12); or health‐related quality of life (two studies, 311 participants; SMD 0.10, 95% CI ‐0.13 to 0.32). The experimental interventions probably result in little or no difference in dropout for any reason (eight studies, 661 participants; risk ratio (RR) 1.15, 95% CI 0.87 to 1.53). In the comparison of experimental interventions with a control condition of information alone, this study found that experimental interventions may result in a slight reduction in caregiver burden (nine studies, 650 participants; SMD ‐0.24, 95% CI ‐0.51 to 0.04); probably result in a slight improvement in depressive symptoms (11 studies, 1100 participants; SMD ‐0.25, 95% CI ‐0.43 to ‐0.06); may result in little or no difference in caregiver health‐related quality of life (two studies, 257 participants; SMD ‐0.03, 95% CI ‐0.28 to 0.21); and probably result in an increase in dropouts for any reason (12 studies, 1266 participants; RR 1.51, 95% CI 1.04 to 2.20). Authors' conclusions: Remotely delivered interventions including support, training or both, with or without information, may slightly reduce caregiver burden and improve caregiver depressive symptoms when compared with provision of information alone, but not when compared with usual treatment, waiting list or attention control. They seem to make little or no difference to health‐related quality of life. Caregivers receiving training or support were more likely than those receiving information alone to drop out of the studies, which might limit applicability. The efficacy of these interventions may depend on the nature and availability of usual services in the study settings.
(Edited publisher abstract)
Subject terms:
informal care, carers, dementia, systematic reviews, training, intervention, evaluation, mobile phones, outcomes, information services, digital technology, computer apps, service provision;