Abstract
BackgroundSeventy percent of people with advanced dementia live and die in care homes. Multisensory approaches, such as Namaste Care, have been developed to improve the quality of life and dying for people with advanced dementia but little is known about effectiveness or optimum delivery. The aim of this review was to develop an explanatory account of how the Namaste Care intervention might work, on what outcomes, and in what circumstances.MethodsThis is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories, and their validation with a purposive sample of stakeholders. Twenty stakeholders - user/patient representatives, dementia care providers, care home staff, researchers -took part in interviews and/or workshops.ResultsWe included 85 papers. Eight focused on Namaste Care and the remainder on other types of sensory interventions such as music therapy or massage. We identified three context-mechanism-outcome configurations which together provide an explanatory account of what needs to be in place for Namaste Care to work for people living with advanced dementia. This includes: providing structured access to social and physical stimulation, equipping care home staff to cope effectively with complex behaviours and variable responses, and providing a framework for person-centred care. A key overarching theme concerned the importance of activities that enabled the development of moments of connection for people with advanced dementia.ConclusionsThis realist review provides a coherent account of how Namaste Care, and other multisensory interventions might work. It provides practitioners and researchers with a framework to judge the feasibility and likely success of Namaste Care in long term settings. Key for staff and residents is that the intervention triggers feelings of familiarity, reassurance, engagement and connection.Study registrationThis study is registered as PROSPERO CRD42016047512
Highlights
Seventy percent of people with advanced dementia live and die in care homes
Description of included evidence Phase 1 In Phase 1 we found 25 papers relating to Namaste Care, 18 of which provided sufficient information for theory development
We have developed an explanation of how the Namaste Care intervention achieves particular outcomes, and in what circumstances
Summary
Seventy percent of people with advanced dementia live and die in care homes Multisensory approaches, such as Namaste Care, have been developed to improve the quality of life and dying for people with advanced dementia but little is known about effectiveness or optimum delivery. Interventions focused on improving end of life care for people with advanced dementia are being developed and tested for use with care home residents [7]. The intervention aims to increase the amount of time staff spend with residents, reduce isolation in people with advanced dementia and improve the quality of living and dying at the end of life. Staff are trained to deliver the programme [9]
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