A Scoping Review of Dementia Symptom Management in Persons with Dementia Living in Home-Based Settings
- 17 Downloads
A large proportion of our older adults live with Alzheimer’s disease and related dementias, and the number of those diagnosed in the future is expected to increase dramatically as the population ages. Persons with dementia bring unique healthcare challenges due to the manifestation of behavioral and psychological symptoms associated with the disease. The lack of geriatric clinicians as well as a properly trained non-geriatric specialist workforce capable of addressing the symptoms persons with dementia exacerbates the challenge of providing effective care. Pharmacological interventions are contraindicated for treatment of most behavioral psychological symptoms of dementia (BPSD). The Centers for Medicare and Medicaid Services now requires that nonpharmacological interventions be used as a first-line treatment. It has not been determined what nonpharmacological intervention for BPSD are most effective and what the infrastructure would entail for such interventions for PWD living at home.
Purpose of Review
The purpose of this study is to examine the literature focusing on interventions aimed towards managing persons’ symptoms of dementia living in home-based settings. A scoping review examining the literature published on this topic over the last 3 years was conducted.
One thousand twenty-four articles were found, of which nine met inclusion criteria. Five articles used occupation-based therapy, two used exercise therapy, and one article was found utilizing aromatherapy and music therapy.
The majority of articles used occupation-based therapy as their intervention for BPSD. Overall, research showed nonpharmacological interventions can be effective in helping mange BPSD in persons living in home-based settings, although maintenance effects of interventions should be further explored in future research as well as how to ensure these interventions are more widely utilized by caregivers in this setting.
KeywordsDementia Nonpharmacological Symptom management Intervention Home-based care
We want to acknowledge Ann Yoo a nursing student from New York University who helped with formatting and data extraction on this article as a research assistant.
This article was partially supported through funding from NIH grants R01AG056610 and R61AG06190
Compliance with Ethical Standards
Conflict of Interest
Catherine E. Schneider, Alycia A. Bristol, and Ab Brody each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 10.Szalontay A, Burtea V, Ifteni P. Predictors of institutionalization in dementia. Rev Cercetare Interventie Soc. 2015;49:249.Google Scholar
- 17.Schwertner E, Secnik J, Garcia-Ptacek S, Johansson B, Nagga K, Eriksdotter M, et al. Antipsychotic treatment associated with increased mortality risk in patients with dementia. A registry-based observational cohort study. J Am Med Dir Assoc. 2019;20(3):323–9 e2. https://doi.org/10.1016/j.jamda.2018.12.019.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Maust DT, Kim HM, Seyfried LS, Chiang C, Kavanagh J, Schneider LS, et al. Antipsychotics, other psychotropics, and the risk of death in patients with dementia: number needed to harm. JAMA Psychiatry. 2015;72(5):438–45. https://doi.org/10.1001/jamapsychiatry.2014.3018.CrossRefPubMedPubMedCentralGoogle Scholar
- 24.National Institute for Health adn Clinical Excellence/Social Care Institute for Excellene. Dementia: supporting people with dementia nard their carers in health and social care. NICE Clinical Guidance 42. London: National Institute for Health and Clinical Excellence; 2007.Google Scholar
- 25.Oliveira AMD, Radanovic M, Mello PCHD, Buchain PC, Vizzotto ADB, Celestino DL, et al. Nonpharmacological interventions to reduce behavioral and psychological symptoms of dementia: a systematic review. Biomed Res Int. 2015.Google Scholar
- 26.Testad I, Corbett A, Aarsland D, Lexow KO, Fossey J, Woods B, et al. The value of personalized psychosocial interventions to address behavioral and psychological symptoms in people with dementia living in care home settings: a systematic review. Int Psychogeriatr. 2014;26(7):1083–98.PubMedCrossRefPubMedCentralGoogle Scholar
- 27.Lepore M, Ferrell A, Wiener JM. Living arrangements of people with alzheimer’s disease and related dementias: implications for services and supports. Washington, DC: Office of the Assistant Secretary for Planning and Evaluation Disability, Aging, and Long-Term Care Policy. 2017.Google Scholar
- 31.• de Oliveira AM, Radanovic M, Homem de Mello PC, Buchain PC, Dias Vizzotto A, Harder J, et al. An intervention to reduce neuropsychiatric symptoms and caregiver burden in dementia: P reliminary results from a randomized trial of the tailored activity program–outpatient version. Int J Geriatr Psychiatry. 2017; This article is “of importance” because it was one of the articles we found in the scoping review of literature that showed positive results from their interveniton using occupaiton therapy at reducing neuropsychiatric symptoms of dementia. It was a rigorous study with high (Level I) levels of evidence through an RCT and the study was conducted within the past 2 years (2017). Google Scholar
- 32.•• Gitlin LN, Arthur P, Piersol C, Hessels V, Wu SS, Dai Y, et al. Targeting behavioral symptoms and functional decline in dementia: a randomized clinical trial. J Am Geriatr Soc. 2018;66(2):339–45 This article is “of outstanding importance” as it was published last year in 2018. They used occupational therapy as an intervention, which showed not only reductions in number of behavioral symptoms of dementia patients, but also reductions in the severity of the behavioral symptoms. These results were found while conducting rigorous research by conduting an RCT, indicating the highest level of evidence. PubMedCrossRefPubMedCentralGoogle Scholar
- 36.Kaymaz TT, Ozdemir L. Effects of aromatherapy on agitation and related caregiver burden in patients with moderate to severe dementia: a pilot study. Geriatr Nurs. 2016;20:1e7.Google Scholar
- 41.• Kaymaz TT, Ozdemir L. Effects of aromatherapy on agitation and related caregiver burden in patients with moderate to severe dementia: A pilot study. Geriatr Nurs. 2017;38(3):231–7 This study is “of importance” because it was conducted with the highest level of evidence (level 1) and showed reductions in MPI scores in the intervention group using aromatherapy. Even though this study is a pilot RCT, it is crucial as it informs future research on what to potentially focus on while developing interventions to improve dementia symptom mangement for patients in the future. CrossRefGoogle Scholar
- 45.Anderson AR, Deng J, Anthony RS, Atalla SA, Monroe TB. Using complementary and alternative medicine to treat pain and agitation in dementia: a review of randomized controlled trials from long-term care with potential use in critical care. Crit Care Nurs Clin. 2017;29(4):519–37.CrossRefGoogle Scholar
- 52.Creavin ST, Wisniewski S, Noel-Storr AH, Trevelyan CM, Hampton T, Rayment D, et al. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev. 2016;1.Google Scholar