Effectiveness of person-centered care on people with dementia: a systematic review and meta-analysis

Abstract

BackgroundPerson-centered care is a holistic and integrative approach designed to maintain well-being and quality of life for people with dementia, and it includes the elements of care, the individual, the carers, and the family.AimA systematic literature review and meta-analysis were undertaken to investigate the effectiveness of person-centered care for people with dementia.MethodsLiterature searches were undertaken using six databases including Medline, EMBASE, CINAHL, PsycINFO, Cochrane Database, and KoreaMed using the following keywords: cognition disorder, dementia, person-centered care, patient-centered care, client-centered care, relationship-centered care, and dementia care. The searches were limited to interventional studies written in English and Korean and included randomized controlled studies and noncontrolled studies for people with dementia living in any setting.ResultsNineteen interventional studies, including 3,985 participants, were identified. Of these, 17 studies were from long-term care facilities and two studies were from homecare settings. The pooled data from randomized controlled studies favored person-centered care in reducing agitation, neuropsychiatric symptoms, and depression and improving the quality of life. Subgroup analysis identified greater effectiveness of person-centered care when implemented for people with less severe dementia. For agitation, short-term interventions had a greater effect (standardized mean difference [SMD]: −0.434; 95% conference interval [CI]: −0.701 to −0.166) than long-term interventions (SMD: −0.098; 95% CI: −0.190 to 0.007). Individualized activities resulted in a significantly greater beneficial effect than standard care (SMD: 0.513; 95% CI: −0.994 to −0.032). However, long-term, staff education, and cultural change interventions had a greater effect on improving the quality of life for people with dementia (SMD: 0.191; 95% CI: 0.079 to 0.302).ConclusionThis systematic review and meta-analysis provided evidence for person-centered care in clinical practice for people with dementia. Person-centered care interventions were shown to reduce agitation, neuropsychiatric symptoms, and depression and to improve the quality of life. Person-centered care interventions can effectively reduce agitation for a short term using intensive and activity-based intervention. However, an educational strategy that promotes learning and skill development of internal care staff is needed to enhance patient’s quality of life and to ensure the sustainability of the effects of behavioral problems. The feasibility and effectiveness of the intervention, the severity of patient disease, and intervention type and duration should be considered as part of an intervention design.

Results from a person‐centered music intervention for individuals living with dementia

“…In a systematic review of 19 interventional studies, person‐centered interventions showed effective reduction in BPSD and improved quality of life for individuals living with dementia . In particular, non‐pharmacological, person‐centered approaches can reduce behavioral challenges and psychotropic medication use for individuals living with dementia, reduce caregiver stress, and prevent harm to the individual or caregiver …”

“…[6][7][8] In a systematic review of 19 interventional studies, person-centered interventions showed effective reduction in BPSD and improved quality of life for individuals living with dementia. 9 In particular, non-pharmacological, person-centered approaches can reduce behavioral challenges and psychotropic medication use for individuals living with dementia, reduce caregiver stress, and prevent harm to the individual or caregiver. 4,7,9,10 A robust and growing body of scientific evidence shows that music has positive emotional effects and physiological reactions, stimulating multiple areas of the brain that oversee emotion, mood control, motor skills, attention and memory.…”

“…9 In particular, non-pharmacological, person-centered approaches can reduce behavioral challenges and psychotropic medication use for individuals living with dementia, reduce caregiver stress, and prevent harm to the individual or caregiver. 4,7,9,10 A robust and growing body of scientific evidence shows that music has positive emotional effects and physiological reactions, stimulating multiple areas of the brain that oversee emotion, mood control, motor skills, attention and memory. 11 Music has been shown to reduce anxiety and agitation, decrease challenging behaviors, and increase memory recall, time spent at meals, and levels of participation, engagement and social behavior.…”

Nursing home care for people with dementia: Update of the design of the Living Arrangements for people with Dementia (LAD)‐study

“…philosophy of care), making sure residents engage in meaningful activities, empowering care staff and changes in the physical environment (i.e. a more home‐like environment) (de Boer, Hamers, Zwakhalen, Tan, & Verbeek, ; Brownie & Nancarrow, ; Grabowski et al, ; Killet et al, ; Kim & Park, ; Koren, ; Te Boekhorst, Depla, De Lange, Pot, & Eefsting, ; Verbeek, van Rossum, Zwakhalen, Kempen, & Hamers, ). It is important to study both the actual person‐centredness of the care provided and these key values, attitudes, and behaviours to advance and improve the implementation of person‐centred care in care homes.…”

The enduring self: personhood, autonomy and compassion in the context of community-based dementia daycare centers

“…In the care setting, the valued concepts of preserving human dignity and autonomy in a compassionate manner, resonates with the construct of person-centered care -"the person comes first" [5]. Such constructs usually surface more prominently in end-of-life issues, especially in cancer palliative care but also arise in dementia care [6]. Dementia care, including the dementia day care setting, end-of-life issues, extend over a long period of time.…”