Do occupational therapy interventions improve quality of life in persons with dementia? A meta‐analysis with implications for future directions

Abstract

Occupational therapy (OT) interventions have shown positive effects on physical functioning in persons with dementia (PwD). However, their effect on quality of life (QoL) has been inconsistent in individual clinical trials. The present review appraises current evidence for the use of OT interventions in improving QoL of PwD. Records in the Cochrane Database, MEDLINE, EMBASE, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature were searched for relevant citations, and PubMed was searched for in-process articles. Additional searches of the reference lists of retrieved articles were undertaken. Ten studies involving 1002 PwD met the criteria for syntheses. OT intervention produced small non-significant improvements in overall QoL. The evidence from the present review does not support the specific use of OT interventions for the improvement of QoL in PwD under pragmatic clinical conditions at this time. They may be best used as part of a comprehensive range of interventions for PwD. Recommendations are made for future design of OT interventions focusing on the improvement of QoL, which is central to the well-being of PwD.

Nonpharmacological Interventions to Improve Depression, Anxiety, and Quality of Life (QoL) in People With Dementia: An Overview of Systematic Reviews

“…Reviews on psychological treatments 35 and cognitive stimulation 25 also demonstrated high methodological quality, with weakness identified for only 1 or 2 critical items. Reviews on massage 30 and occupational therapy 32,33 showed weakness in more than half of the critical items.…”

“…Of the 14 reviews, 8 (57.1%) were Cochrane Reviews. Eleven types of interventions were identified: case management, 23 cognitive training and rehabilitation, 24 cognitive stimulation, 25 exercise, [26][27][28] light therapy, 29 massage, 30 music-based therapeutic sessions, 31 occupational therapy, 32,33 person-centered care, 34 psychological treatment, 35 and reminiscence therapy. 36 Two systematic reviews reporting the efficacy of exercises programs on depression that were published in the same year (ie, no observed difference in recency) were included in the current overview.…”

“…In addition to these 2 reviews, the third review on exercise programs 28 was included in the final data set as this study reported the efficacy of interventions on QoL. Two systematic reviews on occupational therapy 32,33 were also included as they reported different outcomes.…”

“…Occupational therapy. The 2 reviews, one reporting the pooled effect size for depression 32 and the other reporting the pooled effect size for QoL, 33 used the similar definition describing occupational therapy as systematic approaches designed to maintain and enhance the ability to perform ADLs and allow people with dementia to participate in social activities. Randomized controlled trails included in the effect size calculation involved performing functional task activities using practical aids and strategies, environmental modification, and caregiver education and supervision.…”

Occupational therapy for people with dementia and their family carers provided at home: a systematic review and meta-analysis

“…It also involves collaborating with family carers to help them more readily recognise and adjust aspects of the activity and environment that enables this engagement and participation 15 17. Previous systematic reviews have considered the effect of any interventions delivered by a range of health professionals for maintaining occupations broadly to improve or maintain the person’s health and QOL18 19; the effect of occupational therapy interventions specifically on BPSD in a range of different environments20; and the effect of any non-pharmacological intervention (including occupational therapy) on functional decline in people with dementia 21. These reviews either did not use meta-analysis,18 21 included studies with participants from both the community or hospital/aged care settings,18–20 or did not consider outcomes for family carers 20 21…”