Clinician Article

Comparative efficacy of non-pharmacological interventions on agitation in people with dementia: A systematic review and Bayesian network meta-analysis.

  • Leng M
  • Zhao Y
  • Wang Z
Int J Nurs Stud. 2020 Feb;102:103489. doi: 10.1016/j.ijnurstu.2019.103489. Epub 2019 Nov 25. (Review)
PMID: 31862527
Read abstract Read evidence summary
  • FM/GP/Mental Health
    Relevance - 6/7
    Newsworthiness - 6/7
  • Psychiatry
    Relevance - 6/7
    Newsworthiness - 5/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 5/7
    Newsworthiness - 5/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 5/7
    Newsworthiness - 5/7


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.

Clinical Comments

FM/GP/Mental Health

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.

Register for free access to all Professional content

Want the latest in aging research? Sign up for our email alerts.

Support for the Portal is largely provided by the Labarge Optimal Aging Initiative. AGE-WELL is a contributing partner. Help us to continue to provide direct and easy access to evidence-based information on health and social conditions to help you stay healthy, active and engaged as you grow older. Donate Today.

© 2012 - 2020 McMaster University | 1280 Main Street West | Hamilton, Ontario L8S4L8 | +1 905-525-9140 | Terms Of Use