Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials

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

doi:10.1192/bjp.bp.113.141119

Cited by 328 publications

(279 citation statements)

References 59 publications

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“…Rather than two parallel models for antipsychotic prescribing and non‐pharmacological management, our findings support calls for a cohesive model that incorporates the two paradigms (Livingston et al ., 2014). …”

Section: Discussionmentioning

confidence: 99%

The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: a longitudinal cohort study

White

Leurent

Lord

et al. 2016

Int J Geriat Psychiatry

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BackgroundThe acute hospital is a challenging place for a person with dementia. Behavioural and psychological symptoms of dementia (BPSD) are common and may be exacerbated by the hospital environment. Concerns have been raised about how BPSD are managed in this setting and about over reliance on neuroleptic medication. This study aimed to investigate how BPSD are managed in UK acute hospitals.Method(s)A longitudinal cohort of 230 patients with dementia admitted to two acute NHS hospitals. BPSD were measured every four days (Behave‐AD scale), as well as documentation of pharmacological prescriptions and non‐pharmacological management.ResultsThe overall prevalence of BPSD was 75%, with aggression and activity disturbance being the most common. Antipsychotics were prescribed for 28 (12%) patients; 70% of these prescriptions were new on admission. Benzodiazepines were prescribed for 27 (12%) patients, antidepressants were prescribed for 37 (16%) patients, and sedatives were prescribed for 14 (3%) patients. Patients who were prescribed antipsychotics, after adjusting for end of life medication, age and dementia severity, were significantly more likely to die (adjusted hazard ratio 5.78, 95% CI 1.57, 21.26, p = 0.008). Non‐pharmacological management was used in 55% of participants, most commonly psychosocial interventions (36%) with little evidence of monitoring their effectiveness. A form of restraint was used during 50 (22%) patients' admissions.ConclusionsAntipsychotic medications and psychosocial interventions were the main methods used to manage BPSD; however, these were not implemented or monitored in a systematic fashion.

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Section: Discussionmentioning

confidence: 99%

The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: a longitudinal cohort study

White

Leurent

Lord

et al. 2016

Int J Geriat Psychiatry

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“…They recommend future research includes measures on positive outcomes, such as pleasure, quality of relationship, self-management, and resilience. Livingston et al (2014) present evidence of the effectiveness of an 8 session manual-based coping intervention delivered by psychology graduates. The intervention group showed positive effects on carer mood and anxiety levels for 2 years.…”

Section: Implications For Future Research and Practicementioning

confidence: 98%

Psychosocial intervention for carers of people with dementia: What components are most effective and when? A systematic review of systematic reviews

Dickinson

Dow

Gibson

et al. 2016

Int. Psychogeriatr.

139

138

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“…Non-pharmacological interventions can work to reduce BPSD in two ways; directly by targeting behaviours or indirectly by improving quality of life [15]. Care approaches, such as person-centred care [16,17] or seeking to identify and address unmet needs, can also be helpful in the prevention and management of BPSD [14,18,19]. Patel et al [20] argue that there should be a shift in the focus of NPIs, from managing BPSD, to improving well-being to reflect the distinct difference of NPIs from pharmacological interventions.…”

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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Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials

Abstract: There are evidence-based strategies for care homes. Future interventions should focus on consistent and long-term implementation through staff training. Further research is needed for people living in their own homes.

Cited by 328 publications

References 59 publications

The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: a longitudinal cohort study

The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: a longitudinal cohort study

Psychosocial intervention for carers of people with dementia: What components are most effective and when? A systematic review of systematic reviews

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

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