BACKGROUND: Agitation in people with dementia is common and distressing and can lead to increased caregiver burden. However, medications often have adverse reactions and limited effectiveness. Thus, non-pharmacological interventions are being increasingly implemented.
OBJECTIVES: To compare and rank the efficacy of different non-pharmacological interventions in the management of agitation in people with dementia.
DESIGN: Bayesian network meta-analysis.
METHODS: A comprehensive electronic literature search was performed in five English databases and three Chinese databases to identify relevant randomized controlled trials (RCTs) that were published up to January 2019. A random-effects model was selected to conduct traditional meta-analysis to directly examine the efficacy of different non-pharmacological interventions. The consistency model was selected to conduct a network meta-analysis to evaluate the relative effects and rank probability of different non-pharmacological interventions.
RESULTS: A total of 65 RCTs were included in this network meta-analysis involving 11 different non-pharmacological interventions. Network meta-analysis showed that massage therapy, animal-assisted intervention, and personally tailored intervention were associated with more substantial reductions in agitation compared with other interventions and controls.
CONCLUSIONS: Our study confirmed the effectiveness of non-pharmacological interventions for ameliorating agitation in people with dementia and recommended several interventions for clinical practice. Healthcare professionals should be encouraged to apply promising non-pharmacological interventions (e.g. massage therapy, animal-assisted intervention and personally tailored intervention) for people with dementia during routine care.
This is an excellent article with direct clinical applications. There is a dominant tendency to rely solely on pharmacological interventions to control agitation in patients with dementia. This article provides solid evidence to recommend alternative management of agitation. Methodologically, the studies compared in this meta-analysis are very heterogeneous and the conclusions about the relative rank of the different non-pharmacological interventions evaluated should be taken with caution. Nevertheless, the general conclusion of the meta-analysis prevails and should guide clinical practice.