Activity interventions to improve the experience of care in hospital for people living with dementia: a systematic review

Abstract

Background: An increasingly high number of patients admitted to hospital have dementia. Hospital environments can be particularly confusing and challenging for people living with dementia (Plwd) impacting their wellbeing and the ability to optimize their care. Improving the experience of care in hospital has been recognized as a priority, and non-pharmacological interventions including activity interventions have been associated with improved wellbeing and behavioral outcomes for Plwd in other settings. This systematic review aimed at evaluating the effectiveness of activity interventions to improve experience of care for Plwd in hospital. Methods: Systematic searches were conducted in 16 electronic databases up to October 2019. Reference lists of included studies and forward citation searching were also conducted. Quantitative studies reporting comparative data for activity interventions delivered to Plwd aiming to improve their experience of care in hospital were included. Screening for inclusion, data extraction and quality appraisal were performed independently by two reviewers with discrepancies resolved by discussion with a third where necessary. Standardized mean differences (SMDs) were calculated where possible to support narrative statements and aid interpretation. Results: Six studies met the inclusion criteria (one randomized and five non-randomized uncontrolled studies) including 216 Plwd. Activity interventions evaluated music, art, social, psychotherapeutic, and combinations of tailored activities in relation to wellbeing outcomes. Although studies were generally underpowered, findings indicated beneficial effects of activity interventions with improved mood and engagement of Plwd while in hospital, and reduced levels of responsive behaviors. Calculated SMDs ranged from very small to large but were mostly statistically non-significant. Conclusions: The small number of identified studies indicate that activity-based interventions implemented in hospitals may be effective in improving aspects of the care experience for Plwd. Larger well-conducted studies are needed to fully evaluate the potential of this type of non-pharmacological intervention to improve experience of care in hospital settings, and whether any benefits extend to staff wellbeing and the wider ward environment.

Effects of a virtual group cycling experience on people living with dementia: A mixed method pilot study

“…Therefore, research should investigate whether the VCE can be used in other settings such as respite care, in community-dwelling older people and rehabilitation and hospital settings. Activity interventions have the potential to improve mood and engagement of people with cognitive impairment and can be tailored to the preferences and abilities of the participant (Lourida et al, 2020). The VCE can play a unique role in these settings by providing opportunity to undertake light physical activity, while viewing footage of local or familiar locations.…”

Navigating cancer treatment and care when living with comorbid dementia: an ethnographic study

“…Our study has offered significant new insights into the challenges people with dementia and their family members and staff supporting them face when navigating attendance at a hospital for cancer treatment and care. There has been extensive progress in improving the care of people with dementia admitted to acute hospitals [ 17 ] including consideration of how care is delivered [ 18 – 20 ], staff training on dementia [ 21 , 22 ] and the suitability of the physical environment [ 23 ]. However, to date, this has focussed predominantly on in-patient settings [ 24 ] and thus has largely not included out-patient areas including oncology departments.…”

“…There has been extensive progress in improving the care of people with dementia admitted to acute hospitals [17] including consideration of how care is delivered [18][19][20], staff training on dementia [21,22] and the suitability of the physical environment [23]. However, to date, this has focussed predominantly on in-patient settings [24] and thus has largely not included outpatient areas including oncology departments.…”

Nursing interventions to improve care of people with dementia in hospital: a mixed methods systematic review protocol

“…15 There is also an expectation that nursing interventions to improve care will also improve the experience of hospitalization for people with dementia. 16 Moreover, the experiences of nurses providing interventions to improve dementia care in hospitals have also been examined to guide the successful implementation of such interventions in other contexts. 14 The proposed review will synthesize the evidence about the effectiveness of, and experiences with, interventions to improve nursing care of people with dementia.…”