Psychosocial interventions for dementia in low- and middle-income countries (LMICs): a systematic review of effectiveness and implementation readiness

Monisha Lakshminarayanan,Charlotte R. Stoner,Aimee Spector,Helen Durgante

doi:10.1080/13607863.2019.1695742

Abstract

Introduction Despite wide uptake in high-income countries (HICs), less is known about the effectiveness and implementation of psychological, social and cognitive interventions in low- and middle-income countries (LMICs). Despite this, such interventions are increasingly used. The aim of this review was to appraise the effectiveness and implementation readiness of psychosocial interventions for people with dementia in LMICs. Methods A systematic search of databases from 1998–2019. Studies were rated on two scales assessing quality and implementation readiness. Results Seventeen articles describing 11 interventions in six countries were evaluated. Interventions included Cognitive Stimulation Therapy (CST), a Multidisciplinary Cognitive Rehabilitation Programme (MCRP), singing interventions, occupational therapy and reminiscence therapy. The quality of included studies was variable, and many had low sample sizes. Evidence for improving both cognition and quality of life was found in two interventions: Cognitive Stimulation Therapy (CST) and a Multidisciplinary Cognitive Rehabilitation Programme (MCRP). Implementation issues were more likely to be explored in studies of Cognitive Stimulation Therapy (CST) than in any other intervention. Conclusions Of the included studies here, CST appears to be the most implementation ready, improving both cognition and quality of life with implementation readiness effectively explored in two LMIC countries: India and Tanzania.

Highlights

Despite wide uptake in high-income countries (HICs), less is known about the effectiveness and implementation of psychological, social and cognitive interventions in low- and middle-income countries (LMICs)
There are currently 27.3 million people living with dementia in low- and middle-income countries (LMICs), with this number forecast to increase substantially and at a greater rate than in high-income countries (HICs) over the 30 years (Alzheimer’s Disease International, 2015)
Recent awards by United Kingdom (UK) and European funding bodies have included interventions designed to promote independence (Csipke et al, 2018; Wenborn et al, 2016) and improve wellbeing and health (Whitaker et al, 2014), all with psychosocial interventions. Results of such studies have been varied and, despite being widely funded, psychosocial interventions for people with dementia often fail to be ‘scaled up’ or implemented in health services. An exception to this is Cognitive Stimulation Therapy (CST), which has been implemented in approximately 90% of UK Memory Services (Royal College of Psychiatrists, 2016)

Summary

Introduction

Despite wide uptake in high-income countries (HICs), less is known about the effectiveness and implementation of psychological, social and cognitive interventions in low- and middle-income countries (LMICs). Recent awards by UK and European funding bodies have included interventions designed to promote independence (Csipke et al, 2018; Wenborn et al, 2016) and improve wellbeing and health (Whitaker et al, 2014), all with psychosocial interventions Results of such studies have been varied and, despite being widely funded, psychosocial interventions for people with dementia often fail to be ‘scaled up’ or implemented in health services. An exception to this is Cognitive Stimulation Therapy (CST), which has been implemented in approximately 90% of UK Memory Services (Royal College of Psychiatrists, 2016)

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