Key components of person‐centered care for people with dementia: A systematic review of interventions to design a patient preference study

Abstract

AbstractBackgroundTo provide Person‐Centered Care (PCC) for People with Dementia (PwD), patient’s stated preferences must be known. Data about stated care‐preferences among PwD are limited. This study aimed to identify key components of PCC for PwD by a systematic review of PCC‐interventions, to inform the construction of a decision model for PwD‐preference elicitation.MethodA protocol was registered with PROSPERO (CRD42021225084). A search of the concepts Dementia, Person‐Centered Care, and Intervention was performed in PubMed, EMBASE, and Web of Science in Nov2020. Study selection was based on 2‐stage screening against eligibility criteria, limited to randomized controlled trials (RCT) and nonrandomized controlled study (NRS) designs. Risk of bias was assessed with version 2 of the Cochrane risk‐of‐bias tool for randomized trials (RoB2) and the Newcastle‐Ottawa Scale (NOS) for nonrandomized studies. Information about authors, interventions, and outcomes were extracted and entered into an “Effects Table”. The identified PCC‐interventions were thus synthesized into intervention categories to form key components of PCC.ResultSearches identified 1781 records. 19 studies (15 RCT, 4 NRS) were included after screening. The quality of the studies varied between low to moderate. The individual interventions covered a wide range of non‐pharmacological, psychosocial offers, oftentimes bundled in multi‐component intervention‐sets. Nine intervention categories, i.e. key components of PCC to inform the construction of a decision model for PwD‐preference elicitation, emerged from data synthesis: sensory enhancement/relaxation, social contact, cognitive training, validation and reminiscence, physical activities, environmental adjustments, caregiver training and support, care organization and daily living assistance. Effect measures included i.a. agitation, quality of life, antipsychotic use, depression, neuropsychiatric symptoms and behavior, with mixed results concerning the effect of the PCC interventions. All studies were conducted in nursery home or hospital settings.ConclusionNine intervention categories as key components of PCC to inform the construction of a decision model for PwD‐preference elicitation could be identified. As the findings were limited to nursery home and hospital settings, community‐dwelling PwD and the primary care‐setting should find greater consideration for future investigations on PCC interventions and patient preference studies.