A systematic review of appropriateness and effectiveness of management strategies used for the behavioural and psychological symptoms of dementia in the residential care setting.

Abstract

Background The incidence of dementia is increasing throughout the world. People with dementia often require residential care. The management of behaviours in residential care is a significant and stressful part of caring for people with dementia. The ability to apply appropriate and effective management strategies to these behaviours is vital to maintain the safety of the person with dementia and the people who live with them and care for them. Objectives The aim of this review is to identify and synthesise the best available evidence of the appropriateness and effectiveness of different strategies used to manage the behavioural and psychological symptoms of dementia in the residential care setting. Inclusion criteria Types of participants Adults aged 65 years and older regardless of gender, ethnicity, co-morbidities who reside in a residential care facility. The subjects must have a diagnosis of dementia and exhibit behaviours which require a degree of modification or management so that they can be safely managed in a residential care facility. Types of interventions/Phenomenon of Interest Interventions types examined in this review were: Standard behavioural therapies, Alternative therapies, Complementary therapies, Psychotherapies, Environmental factors, Pharmacological interventions. Types of studies This comprehensive review considered both qualitative and quantitative studies. Included quantitative studies were randomized control trials, case control and cohort studies. The qualitative studies focused on the experiences of the people with dementia and the people who care for them. Types of Outcome Measures There was a wide range of outcome measures in the selected studies. The outcome strategies focused on both prevalence and severity of behaviours to illustrate effectiveness of interventions. Search Strategy Both published and unpublished English language studies were considered, from inception of the eight databases searched up to March 2012. A three-step search strategy was utilized in each component of this review. Methodological quality 20 papers were assessed for methodological quality by two independent reviewers, using standardised Joanna Briggs Institute instruments. Of these papers, two were qualitative and the remaining 18 were quantitative through this process studies were considered to be of moderate to high quality as assessed against the Joanna Briggs critical appraisal tools. No studies were excluded based on methodological quality. Data Collection and Data Synthesis Data was extracted using standardized data extraction tools. Meta-analysis of quantitative data was appropriate for two of the studies, it was not attempted on the others due to lack of clinical and statistical heterogeneity; therefore findings are presented as a narrative. Meta-aggregation of qualitative findings was conducted in order to generate synthesised findings. Results 20 papers were identified for this systematic review. 18 of these papers were quantitative and two were qualitative. These papers described effective and appropriate management of the behavioural and psychological symptoms using a variety of methods, pharmacological and non-pharmacological. Conclusion Effectiveness in management of behavioural and psychological symptoms of dementia is dependent on correct diagnosis of the behaviour and the detection of underlying pathology organic or psychiatric. Interventions need to be targeted at the resident and based on the residents lived experiences.