Effective use of the built environment to manage behavioural and psychological symptoms of dementia: a systematic review.

Lesley J J Soril,Fiona M Clement,Lynne Mansell,James Silvius,Tom W Noseworthy,Jayna Holroyd-Leduc,Diane L Lorenzetti,Duncan Robertson,Laura E Leggett,Jerson Laks

doi:10.1371/journal.pone.0115425

Abstract

ObjectiveTo determine the effectiveness of built environment interventions in managing behavioural and psychological symptoms of dementia (BPSD) among residents in long-term care settings.MethodsSystematic review of literature published from 1995–2013. Studies were included if they: were randomized controlled trials, quasi-experimental trials, or comparative cohort studies; were in long-term or specialized dementia care; included residents with dementia and BPSD; and examined effectiveness of a built environment intervention on frequency and/or severity of BPSD. Quality of included studies was assessed using the Downs and Black Checklist. Study design, patient population, intervention, and outcomes were extracted and narratively synthesized.ResultsFive low to moderate quality studies were included. Three categories of interventions were identified: change/redesign of existing physical space, addition of physical objects to environment, and type of living environment. One of the two studies that examined change/redesign of physical spaces reported improvements in BPSD. The addition of physical objects to an existing environment (n = 1) resulted in no difference in BPSD between treatment and control groups. The two studies that examined relocation to a novel living environment reported decreased or no difference in the severity and/or frequency of BPSD post-intervention. No studies reported worsening of BPSD following a built environment intervention.ConclusionsThe range of built environment interventions is broad, as is the complex and multi-dimensional nature of BPSD. There is inconclusive evidence to suggest a built environment intervention which is clinically superior in long-term care settings. Further high-quality methodological and experimental studies are required to demonstrate the feasibility and effectiveness of such interventions.

Highlights

Alzheimer’s disease and related dementias are chronic, progressive disorders that result in the impairment of cognitive functions, including memory, orientation, comprehension, and executive function [1,2,3]
There is inconclusive evidence to suggest a built environment intervention which is clinically superior in long-term care settings
Recent systematic reviews concerning the use of pharmacological interventions for the treatment of behavioural and psychological symptoms of dementia (BPSD), antipsychotic medications, conclude that while these drugs may be moderately effective or ineffective at reducing the frequency and/or severity of responsive behaviours, they are associated with an increased risk of major adverse events and death [10, 11]

Summary

Introduction

Alzheimer’s disease and related dementias are chronic, progressive disorders that result in the impairment of cognitive functions, including memory, orientation, comprehension, and executive function [1,2,3]. There is growing evidence to suggest that the management of BPSD in LTC should shift from the traditional practice of medication-based symptom management, to comprehensive non-pharmacological approaches grounded on maintaining the physical and emotional comfort of the individual within their environment [8, 11, 12]. Such non-pharmacological interventions may be applied to an individual (e.g. massage, music therapy and animal-assisted therapy) [13, 14] or related to the physical living setting or built environment [11, 12, 15]

Methods

Results

Discussion

Conclusion