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Personally tailored activities for improving psychosocial outcomes for people with dementia in long-term care (review)
- Authors:
- MOHLER R, et al
- Publisher:
- John Wiley and Sons
- Publication year:
- 2018
- Pagination:
- 75
Background: People with dementia who are being cared for in long-term care settings are often not engaged in meaningful activities. Offering them activities which are tailored to their individual interests and preferences might improve their quality of life and reduce challenging behaviour. Purpose of this review: To investigate the effects of offering people with dementia who were living in care homes activities tailored to their personal interests. Eight studies including 957 people with dementia living in care homes were included in the review. Seven of the studies were randomised controlled trials (RCTs). The number of participants included in the studies ranged from 25 to 180. They all had moderate or severe dementia and almost all had some kind of challenging behaviour when the study started. The studies lasted from 10 days to nine months. In all the studies, the people in the intervention groups got an individual activity plan. Most of the activities took place in special sessions run by trained staff, but in one study, the nursing staff were trained to provide the activities during the daily care routine. The activities actually offered in the different studies did not vary a lot, but the number of activity sessions per week and the duration of the sessions did vary. The quality of the trials and how well they were reported varied, and this affected confidence in the results. Key findings: Offering personally tailored activities to people with dementia living in care homes may slightly improve challenging behaviour when compared with usual care, although the authors did not find evidence that it was any better than offering activities which were not personally tailored. In one study, staff members reported that people in the group receiving personally tailored activities had a slightly worse quality of life than the control group. Personally tailored activities may have little or no effect on the negative emotions expressed by the participants. Because the quality of some of the evidence was very low, conclusions could not be drawn about effects on the participants' positive emotions, mood, engagement (being involved in what is happening around them) or quality of sleep. Only two studies mentioned looking for harmful effects; none were reported. None of the studies measured effects on the amount of medication participants were given, or effects on carers. Authors' conclusions: Offering personally tailored activities to people with dementia in long-term care may slightly improve challenging behaviour. Evidence from one study suggested that it was probably associated with a slight reduction in the quality of life rated by proxies, but may have little or no effect on self-rated quality of life. The authors acknowledge concerns about the validity of proxy ratings of quality of life in severe dementia. Personally tailored activities may have little or no effect on negative affect and it is uncertain whether they improve positive affect or mood. There was no evidence that interventions were more likely to be effective if based on one specific theoretical model rather than another. Our findings leave us unable to make recommendations about specific activities or the frequency and duration of delivery. Further research should focus on methods for selecting appropriate and meaningful activities for people in different stages of dementia. (Edited publisher abstract)