What we did
People with dementia are often prescribed antipsychotics on entering residential care to help reduce responsive behaviours. [1] There is strong evidence suggesting risks associated with these drugs, including dizziness, drowsiness, disorientation, and falls. [1] Researchers are therefore working to find non-drug approaches for improving the quality of life and care for people with dementia. To understand the scope of this research, we undertook a scoping review of systematic reviews on non-drug interventions for dementia within the aged care context.
What we found
The scoping review identified 200 reviews on dementia in the aged care context published since 2011. From these reviews we identified dementia topics for which there is an established body of evidence. These topics have become the ‘evidence themes’ within the Knowledge Hub. They include training and support for family carers, physical activity, and psychological therapies for people living with dementia. Responsive behaviours (also known as ‘behavioural and psychological symptoms of dementia’) were the most frequently researched outcome of interest to researchers.
Most reviews highlight difficulties in drawing conclusions on the effectiveness of interventions due to large differences between how the intervention was administered (i.e., what participants were asked to do, for how often and for how long.) Also, many dementia studies had only a small number of people in them. This makes it hard to judge if the findings can be generalised to other people. These methodological shortcomings may reflect the challenges of conducting research with people living with dementia.
Conclusion
To date, many of the studies exploring non-drug therapies for people with dementia are inconclusive, have contradictory findings, or demonstrate a low to moderate effect. [2] However, we are likely to gain more confidence in the dementia evidence as it accumulates over time. We can also gain valuable knowledge from innovative programs currently taking place in aged care settings that evaluate their effectiveness and make this information publicly available. [3]
What does this mean for practice
While the evidence supporting non-drug approaches to dementia care is not as conclusive as we might like, we do know that these approaches:
- have shown some effectiveness
- are unlikely to cause harm
- offer opportunities to increase social engagement with others
- often require little training to administer
- can be considered person-centred and respectful of people as unique individuals
- are well accepted and even enjoyed by people with dementia
- do not require a large organisational investment in resources. [2]
These findings suggest that non-drug approaches to care of the person with dementia are worth trialling for these underlying benefits, in addition to their potential effectiveness.