A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia

Livingston, Gill; Kelly, L. A.; Lewis-Holmes, Elanor; Baio, Gianluca; Morris, Stephen; Patel, Nishma; Omar, Rumana; Katona, Cornelius; Cooper, Claudia

doi:10.3310/hta18390

Cited by 151 publications

(168 citation statements)

References 1,251 publications

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“…Lack of awareness of the benefits of music therapy and its cost-effectiveness may hinder expansion within hospital services. Although a hospital based cost-effectiveness study comparing music therapy with other healthcare programmes could not be found, several reports have examined this assessment in nursing homes 37 38. In a study conducted in Italy, the cost of a single music therapy session per patient was roughly €6.17 37.…”

Section: Discussionmentioning

confidence: 99%

Perceptions of music therapy for older people among healthcare professionals

et al. 2015

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Purpose of study: To investigate the perceptions of healthcare providers on music therapy and their recommendations on wider adoption in a hospital setting. Design and methods:A qualitative exploratory study employing short semi structured interview using thematic analysis method of data analysis.Intervention: A qualitative exploratory study, employing short semi structured interviews was conducted in March 2015 in an urban teaching hospital to explore healthcare providers attitudes towards and recommendations on music therapy. Convenience sampling was used for recruitment of hospital staff from a multidisciplinary geriatric unit. Only staff who had exposure, awareness, or participated in the hospital music therapy program were asked to partake in an in-depth qualitative interview. Main findings:Themes emerging reflected a belief among hospital staff that music therapy was of benefit to patients and staff; perceptions of how a hospital music therapy program should be implemented and a desire for expansion of the music therapy programme throughout the hospital setting.Principal Conclusions: Music therapy is of great importance to both patients and healthcare professionals, and thus more attention is warranted to better integrate and advance this program. This study is important because although numerous studies have examined music therapy from a patient health perspective, no report has analyzed the perceptions of healthcare providers on this intervention and their recommendations on further development of music therapy services.

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Section: Discussionmentioning

confidence: 99%

Perceptions of music therapy for older people among healthcare professionals

et al. 2015

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“…However, NPIs may need to be individually tailored [24], can be costly to implement [25], and are often time-consuming and reliant on the availability of knowledgeable staff [26]. Additionally, little is known about potential harms of NPIs [27].…”

Section: Introductionmentioning

confidence: 99%

The use of non-pharmacological interventions for dementia behaviours in care homes: findings from four in-depth, ethnographic case studies

2016

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BackgroundAntipsychotic medications have been used to manage behavioural and psychological symptoms of dementia (BPSD). Due to the potential risks associated with these medications for people with dementia, non-pharmacological interventions have been recommended as safer alternatives. However, it is unknown if, or how, these interventions are used in care homes to help people experiencing BPSD. AimTo explore the use of non-pharmacological interventions in care homes to manage behavioural and psychological symptoms of dementia. MethodsIn-depth, ethnographic case studies were conducted in 4 care homes; in total they included interviews with 40 care-home staff and 384 hours of participant observations. FindingsNon-pharmacological interventions, some of which are the focus of efficacy research, were used in care homes, but predominantly as activities to improve the quality of life of all residents and not identified by staff as meeting individual needs in order to prevent or manage specific behaviours. Socially relevant activities such as offering a cup of tea were used to address behaviours in the moment. Residents with high levels of need experienced barriers to inclusion in the activities. ConclusionsThere is a gap between rhetoric and practice with most non-pharmacological interventions in care homes used as social activities rather than as targeted interventions. If nonpharmacological interventions are to become viable alternatives to antipsychotic medications in care homes further work is needed to embed them into usual care practices and routines. Training for care-home staff could also enable residents with high needs to gain better access to suitable activities.2

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“…12,13 The effect of THC on the endocannabinoid system is mediated by 2 cannabinoid receptors: CB 1 receptors are expressed in several brain regions, especially the basal ganglia, cerebellum, hippocampus, amygdala, and hypothalamus; CB 2 receptors are primarily found in cells and organs of the immune system. Therefore, THC probably has a wide range of CB 1 -mediated receptor interactions with the endocannabinoid system affecting emotion, cognition, and behavior.…”

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confidence: 99%

Tetrahydrocannabinol for neuropsychiatric symptoms in dementia

et al. 2015

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Objective: To study the efficacy and safety of low-dose oral tetrahydrocannabinol (THC) in the treatment of dementia-related neuropsychiatric symptoms (NPS).Methods: This is a randomized, double-blind, placebo-controlled study. Patients with dementia and clinically relevant NPS were randomly assigned to receive THC 1.5 mg or matched placebo (1:1) 3 times daily for 3 weeks. Primary outcome was change in Neuropsychiatric Inventory (NPI), assessed at baseline and after 14 and 21 days. Analyses were based on intention-to-treat.Results: Twenty-four patients received THC and 26 received placebo. NPS were reduced during both treatment conditions. The difference in reduction from baseline between THC and placebo was not significant (mean difference NPI total : 3.2, 95% confidence interval [CI] 23.6 to 10.0), nor were changes in scores for agitation (Cohen-Mansfield Agitation Inventory 4.6, 95% CI 23.0 to 12.2), quality of life (Quality of Life-Alzheimer's Disease 20.5, 95% CI 22.6 to 1.6), or activities of daily living (Barthel Index 0.6, 95% CI 20.8 to 1.9). The number of patients experiencing mild or moderate adverse events was similar (THC, n 5 16; placebo, n 5 14, p 5 0.36). No effects on vital signs, weight, or episodic memory were observed.Conclusions: Oral THC of 4.5 mg daily showed no benefit in NPS, but was well-tolerated, which adds valuable knowledge to the scarce evidence on THC in dementia. The benign adverse event profile of this dosage allows study of whether higher doses are efficacious and equally welltolerated. Classification of evidence:This study provides Class I evidence that for patients with dementiarelated NPS, low-dose THC does not significantly reduce NPS at 21 days, though it is welltolerated. Neurology ® 2015;84:2338-2346 GLOSSARY AD 5 Alzheimer disease; AE 5 adverse event; CCGIC 5 Caregiver Clinical Global Impression of Change; CI 5 confidence interval; CMAI 5 Cohen-Mansfield Agitation Inventory; NPI 5 Neuropsychiatric Inventory; NPS 5 neuropsychiatric symptoms; PAL WMS-R 5 Paired Associate Learning Wechsler Memory Scale-Revised; QoL-AD 5 Quality of Life-Alzheimer's Disease Scale; RCT 5 randomized controlled trial; THC 5 D-9-tetrahydrocannabinol.

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A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia

Cited by 151 publications

References 1,251 publications

Perceptions of music therapy for older people among healthcare professionals

Perceptions of music therapy for older people among healthcare professionals

The use of non-pharmacological interventions for dementia behaviours in care homes: findings from four in-depth, ethnographic case studies

Tetrahydrocannabinol for neuropsychiatric symptoms in dementia

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