Non-pharmacological approaches for dementia that informal carers might try or access: a systematic review

HULME Claire, et al
Journal article citation:
International Journal of Geriatric Psychiatry, 25(7), July 2010, pp.756-763.

The objective of this paper is to review non-drug treatments for dementia and to provide a source of evidence for informal carers who want ideas about non-drug approaches for dementia. A systematic review was performed to address questions regarding what non-drug treatments work and what for, what might work, and what do not work. Literature searches of 7 electronic databases were carried out in November 2007 in order to identify systematic reviews. The searches identified 33 reviews of which 25 were judged to be high or good quality. Studies within these systematic reviews were characterised by weak study designs with small sample numbers. Three interventions were found to be effective for use with particular symptoms of dementia: music or music therapy, hand massage or gentle touch and physical activity. The review concludes that whilst informal carers can apply some of the interventions highlighted in the home setting at little or no cost to themselves or to health or social care services, others are likely to require training or instruction. Service providers and commissioners should explore current and future provision of more structured group activities for people with dementia; in particular the provision of group music therapy and group exercise activities that meet the needs of both the person with dementia and their carer.

Extended abstract:

HULME Claire; et al.;

Non-pharmacological approaches for dementia that informal carers might try or access: a systematic review.

Journal citation/publication details

International Journal of Geriatric Psychiatry, 25(7), July 2010, pp.756-763.


Thirty-three systematic reviews assessing a total of 16 types of non-drug interventions were included in this study. There was some indication that three approaches – music/music therapy, hand massage/gentle touch, and physical activity – may be beneficial for some emotional and behavioural problems but, in general, the evidence was weak.


Informal carers of people suffering from dementia often have to deal with associated emotional and behavioural problems such as depression, aggression, and wandering. Some sources have suggested that carers’ interventions are sometimes as effective as drug treatment in dealing with these problems. The aim of this study was to ‘review non-drug treatments for dementia; to provide a source of evidence for informal carers’.


What sources were searched?
The following databases were searched from 2001 to 2007: AMED, CINAHL, EMBASE, Medline, PsycINFO, Cochrane Library Systematic Reviews, and DARE.

What search terms/strategies were used?
Terms for dementia and Alzheimer’s, review, and non-drug therapies were used in the search. Specific details of the terms and the searches employed are not reported.

What criteria were used to decide on which studies to include?
Only systematic reviews including at least one randomised controlled trial of one or more non-drug intervention for dementia, published in English from 2001 onwards, were eligible. Studies set in acute settings, long term care facilities, or residential care settings were excluded.

Who decided on their relevance and quality?
Articles were initially screened using titles and abstracts; the full text of potentially relevant studies was then obtained and examined in detail. Quality was assessed using NICE methodological checklists and studies were rated high, good or low. It is not clear who was responsible for study selection or quality assessment.

How many studies were included and where were they from?
Of the 784 references originally identified 114 were considered potentially relevant and were examined in full. Thirty five articles representing 33 studies were included in the review. 

How were the study findings combined?
Data was extracted using a template developed by NICE. Evidence is presented as a narrative synthesis under headings for each intervention type.

Findings of the review

The number of reviews identified for each intervention type was: one for acupuncture, counselling, and TENS (Transcutaneous Electrical Nerve Stimulation); two for animal assisted therapy, and environmental manipulation; three for aromatherapy, behaviour management, massage/touch therapies, reality orientation, and validation therapy; four for light therapy, and reminiscence therapy; five for cognitive stimulation therapy, and physical activity; six for multi-sensory stimulation; and ten for music/music therapy.

Seventeen studies were rated as high quality, eight were of good quality, and eight were of low quality. Only six studies were limited to a specific stage or type of dementia. The majority of the studies were based in community residential settings. Interventions were assessed against a range of symptoms which were grouped under three headings: cognitive ability, ability to perform activities of daily living, and behavioural/psychological symptoms.

Some evidence of beneficial effects related to specific symptoms of dementia was found for music or music therapy, hand massage or gentle touch, and physical activity. Inconclusive results were reported for all of the other intervention categories, apart from acupuncture and counselling for which there was no evidence of any beneficial effects.

Authors' conclusions

‘The evidence presented suggests three different interventions effective for people with dementia. Music or music therapy, hand massage or gentle touch, and physical activity or exercise. However even for these interventions the evidence is mixed or limited.’

Implications for policy or practice

The provision of group music therapy and group exercise programmes that meet the needs of dementia sufferers and their carers is recommended.

Subject terms:
music therapy, physical exercise, carers, complementary therapies, dementia;
Content type:
systematic review
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