Psychosocial interventions for dementia: from evidence to practice

Abstract

ARTICLEThis article is an update to the overview in Advances by Douglas et al (2004). We summarise the most well-researched psychosocial approaches for dementia by focusing on those with goodquality evidence, and acknowledge some of the newer and less-researched interventions listed in Box 1.The recurrent theme throughout the literature regarding the efficacy of non-pharmacological interventions for dementia is the need for more robust evidence. Reasons for this include that research funding is largely targeted at biomedical approaches and that study designs are not always a good fit for the outcomes measured. Kitwood (1997) proposed that a person-centred approach should be the bedrock for supporting people with dementia. The essential tenet is that personhood remains throughout the experience of dementia and it is the caregiver's responsibility to ensure that it is maintained. Person-centred practice recognises the underlying needs of the individual, often expressed through behaviour. The paradigm shift from 'managing' behavioural and psychological symptoms of dementia (BPSD) towards improving well-being, engagement and quality of life represents a significant change. These goals are more hopeful, leaving therapeutic nihilism in the past. Reducing antipsychotic prescribing (Banerjee 2009) presents another opportunity to exploit these approaches. A review of 26 non-pharmacological intervention categories concluded that non-pharmacological therapies are useful, versatile and potentially cost-effective in improving outcomes and quality of life (Olazarán 2010); however, they necessitate staff time, raising issues regarding priorities and risk (Lawrence 2012).The essential component is the belief that distress and behaviour are expressions of unmet need -all behaviour having meaning -and are a response to the challenges dementia presents (Kitwood 1997). The key appears to be formulation or behavioural analysis (Moniz-Cook 2012) to understand the behaviour and its function for each person. is not yet robust enough to clearly suggest which interventions are most suited for which environment. However, from our literature review there appears to be reason to use music therapy, aromatherapy, life story work, animal-assisted therapy and post-diagnosis/carer support work. We focus on both the traditional outcome measures of behavioural and psychological symptoms of dementia (BPSD) and the more difficult to measure, but equally important, person-centred outcomes of non-pharmacological interventions, as their properties are distinctly different from those of pharmacological agents. LEARNING OBJECTIVES•• Be aware of the range of psychosocial interventions.•• Have a better understanding of the possible outcomes from given interventions.•• Be aware of the paradigm shift from managing BPSD to a person-centred approach that focuses on the patient's well-being and quality of life. DECLARATION OF INTERESTNone.BOX 1 Psychosocial approaches for dementia that are in use but research is ongoing

Living Better With Dementia: Strengths-Based Social Work Practice and Dementia Care

“…The use of techniques such as fostering we-ness with a family systems approach, promoting a strengths perspective and building on self disclosure should be further tested in psycho-social interventions to discover their potential to better meet needs of families and care partnerships instead of only individuals (Patel, Perera, Pendleton, Richman, & Majumdar, 2014). Deepening understanding of how to nurture and highlight a sense of weness; foster trust and bridge the gap between "us" and "them" between practitioner and client; and focus on quality of life rather than cure may increase resources and create new outcomes for affected families.…”

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

“…Non-pharmacological interventions, such as aromatherapy, music therapy or massage, were not being used as first-line treatments for BPSD in these four care homes. Instead, in-line with the recommendation from Patel et al [20], NPIs were predominantly viewed, and used, as activities and aimed at the whole group of residents of the home as a means to improve quality of life/well-being. In this way it is likely the activities could have contributed to a person-centred care approach [16,17], addressed unmet needs [14,18,19], and improved 13 the general psychosocial environment for all residents, all of which could have benefitted people with dementia and pre-empted instances of BPSD.…”

“…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.…”

A Mini-Review of Virtual Reality-Based Interventions to Promote Well-Being for People Living with Dementia and Mild Cognitive Impairment

“…Psychosocial interventions are proposed to reduce the burden of disease, particularly if introduced during the early stages of dementia [5-7]. Current psychosocial interventions for dementia include mindfulness-based activities, life review or storytelling, and music- and art-based therapies [5, 7].…”