Abstract
Background Two-thirds of people living with dementia live at home in the UK and many experience distressing behavioural and psychological symptoms. This systematic review evaluates the effectiveness of non-pharmacological interventions for behavioural and psychological symptoms among community-dwelling people living with dementia. Methods This two-stage review undertook an initial mapping of the literature followed by a systematic review of relevant randomised controlled trials. We searched electronic databases for pertinent studies reporting outcomes from interventions from January 2000 to March 2015 and updated searches in October 2016. We included studies that considered behavioural and psychological symptom management for older people living with dementia who live at home and excluded studies conducted in long-term care settings. This paper presents findings from a narrative synthesis of 48 randomised controlled trials evaluating interventions for people living with dementia alone, family carers alone and patient-carer dyads. Results We retrieved 17,871 de-duplicated records and screened them for potential inclusion. Evidence from 48 randomised controlled trials suggests that family carer training and educational programmes that target problem behaviours and potential triggers can improve outcomes. Nurses and occupational therapists appear to help people with dementia with behavioural and psychological symptoms, but professional comparisons are lacking and there is no shared language about or understanding of behavioural and psychological symptoms amongst professionals, or between professionals and family carers. Conclusions Future research should focus on the effectiveness of components of multi-faceted programmes and their cost effectiveness and include qualitative data to better target interventions for behavioural and psychological symptoms. It is important to consider family carer readiness to use non-pharmacological strategies and to develop a shared language about the inherent needs and communications of behavioural and psychological symptoms.
Highlights
Two-thirds of people living with dementia live at home in the United Kingdom (UK) and many experience distressing behavioural and psychological symptoms
The interventions targeted people living with dementia and family carers, were delivered at home or in community or out-patient settings and were often multi-faceted and multidisciplinary
We evaluated evidence from 48 randomised controlled trials (RCTs) describing seven broad groups of nonpharmacological interventions that addressed the management of behavioural and psychological symptoms of dementia (BPSD) for both people living with dementia and their family carers living in the community
Summary
Two-thirds of people living with dementia live at home in the UK and many experience distressing behavioural and psychological symptoms. This paper presents findings from a narrative synthesis of 48 randomised controlled trials evaluating interventions for people living with dementia alone, family carers alone and patient-carer dyads. Two-thirds of people living with dementia in the United Kingdom (UK) live at home and most experience non-cognitive behavioural and psychological symptoms of dementia (BPSD) These symptoms may result in distress, increased service use and an unwanted move to a care home (Robinson et al, 2006; Savva et al, 2009). Psychosis, aggression, wandering or walking, agitation, apathy and emotional distress These can limit the ability to sustain everyday activities and reduce quality of life (QoL) for all those affected (Kales et al, 2015). They can cause or exacerbate sleep deprivation, fatigue and eating problems (Manthorpe & Watson, 2003; Watson & Green, 2006)
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