Managing behavioural and psychological symptoms in community dwelling older people with dementia: 1. A systematic review of the effectiveness of interventions

Abstract

Background Two-thirds of people living with dementia live at home in the UK and many experience distressing behavioural and psychological symptoms. This systematic review evaluates the effectiveness of non-pharmacological interventions for behavioural and psychological symptoms among community-dwelling people living with dementia. Methods This two-stage review undertook an initial mapping of the literature followed by a systematic review of relevant randomised controlled trials. We searched electronic databases for pertinent studies reporting outcomes from interventions from January 2000 to March 2015 and updated searches in October 2016. We included studies that considered behavioural and psychological symptom management for older people living with dementia who live at home and excluded studies conducted in long-term care settings. This paper presents findings from a narrative synthesis of 48 randomised controlled trials evaluating interventions for people living with dementia alone, family carers alone and patient-carer dyads. Results We retrieved 17,871 de-duplicated records and screened them for potential inclusion. Evidence from 48 randomised controlled trials suggests that family carer training and educational programmes that target problem behaviours and potential triggers can improve outcomes. Nurses and occupational therapists appear to help people with dementia with behavioural and psychological symptoms, but professional comparisons are lacking and there is no shared language about or understanding of behavioural and psychological symptoms amongst professionals, or between professionals and family carers. Conclusions Future research should focus on the effectiveness of components of multi-faceted programmes and their cost effectiveness and include qualitative data to better target interventions for behavioural and psychological symptoms. It is important to consider family carer readiness to use non-pharmacological strategies and to develop a shared language about the inherent needs and communications of behavioural and psychological symptoms.

Palliative care for people with dementia living at home: A systematic review of interventions

“…[28][29][30] Healthcare practitioners are often uncertain how to support people with dementia whose behaviours they find challenging. 31 Pain is also highly prevalent in older adults but poorly assessed in those with dementia, 30,32 which may result in patient distress and related behaviours. 33 Managing behavioural symptoms and assessing pain are not only important for patients with dementia.…”

<p>Dementia-related neuropsychiatric symptoms: inequalities in pharmacological treatment and institutionalization</p>

“…The strong discordance between drug prescription and the percentage of patients formally diagnosed with NPS reinforces the need for a thorough understanding of these indicators. The existence of an increase in nursing-home admissions associated with the prescription of antidepressants and antipsychotics fits well with higher family distress related to psychotic or behavior disorders 30,31…”

“…But, as the Organisation for Economic Co-operation and Development has remarked, a big data approach offers new tools to identify in clinical databases (broad data) patterns in cases of dementia requiring specific care 32. The term NPS is conceptually related to challenging behavior30 since these symptoms pose situations that cannot be managed in their environment without resorting to pharmacological treatment. Therefore, in the context of the natural history of dementia characterized by a progression in time, it seems reasonable to use psychoactive medication as a milestone that indicates that, beyond the physical functioning of the patient, NPS present a severe problem that requires intensive social care 33.…”

The Quality of Carer–Patient Relationship Scale: Adaptation and Validation into Portuguese

“…Being a carer of someone with a neurocognitive disorder (NCD), commonly referred to as dementia [2], can be a strain in many dimensions, including emotional, social, and physical [3,4]. In addition, there are often various neuropsychiatric symptoms (NPS) that accompany this degenerative process such as restlessness, mood disturbances, and disorientation, which increase the complexity of informal care [4,5]. The presence of such NPS can lead to significantly more physical and emotional demand on the carer, which can affect the quality of the carer's relationship with the cared-for person [6][7][8].…”