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In people with dementia who live in care homes, training and supervising paid caregivers in person-centered care and communication skills reduces agitation

Livingston G, Kelly L, Lewis-Holmes E, et al. Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials.  Br J Psychiatry. 2014;205:436-42.

Review question

In people with dementia, do interventions other than drugs reduce agitation?

Background

Many people with dementia become agitated at times (e.g., pace, wander, become restless or aggressive, or have physical or verbal outbursts). Agitation can be distressing for people with dementia and their caregivers.

Interventions that prevent or decrease agitation in people with dementia may reduce distress.

How the review was done

The researchers did a systematic review, searching for studies that were published up to June 2012.

They found 33 randomized controlled trials, each with between 47 and 306 people.

The key features of the randomized controlled trials were:

  • all people had dementia and most lived in care homes (e.g., nursing homes or long-term care homes that provide support for doing everyday things such as eating and getting around);
  • most people had no or some agitation at the start of the trials;
  • interventions were intended to reduce agitation and included sensory stimulation (e.g., therapeutic touch, acupressure, hand massage, and calm music); training, with or without supervision, of paid caregivers in person-centered care (strategies focused on needs and values of persons with dementia) and communication skills; specific activities (e.g., those that fit with how a person functions or their emotional state); bright light therapy; structured music therapy; aromatherapy, including massage with oils; training for family caregivers in cognitive-behavioural therapy (focused on changing problem thoughts, feelings, and behaviours) or behavioural management therapy (focused on ways to encourage wanted and discourage unwanted behaviours); exercise; simulated presence (playing recordings of relatives talking); and combinations of interventions; and
  • most interventions were compared with usual care or placebo.

What the researchers found

8 studies across multiple interventions were of high quality. Findings from the randomized controlled trials are reported in the Table.

Conclusions

Training paid caregivers in person-centred care or communication skills and supervising them during training reduces agitation in people with dementia who live in care homes. Working with people with dementia on specific activities also reduces agitation.

Nondrug interventions vs control* for reducing agitation in people with dementia

Interventions

Number of trials and people

Effects on agitation during intervention

Effects on agitation after intervention

Training with supervision for paid caregivers in person-centered care or communication skills

6 trials ( 921 people with no, some, or severe agitation)

Reduced some measures in 6 trials

Reduced some measures at 8 weeks to 6 months in 5 trials

Training without supervision for paid caregivers in person-centered care or communication skills

2 trials (237 people with no agitation)

No effect in 2 trials

No effect at 15 weeks in 1 trial

Training family caregivers in cognitive-behavioural or behavioural management therapy

4 trials (294 people with some or severe agitation)

No effect in 2 trials

Effect unclear in 1 trial

No effect in 3 trials

Effect unclear in 1 trial

Activity-based interventions

5 trials (510 people with no or some agitation)

Reduced in 4 trials

No effect in 1 trial

No effect at 1 week in 1 trial

Sensory interventions

6 trials (501 people with no or some agitation)

Reduced in 1 trial using acupressure, 1 trial using hand massage with or without calm music, and 1 trial of Snoezelen therapy (some measures)

No effect in 3 trials using therapeutic touch therapy

No effect in 2 trials using therapeutic touch therapy

Light therapy

3 trials (210 people with some or severe agitation)

Increased in 2 trials

No effect in 1 trial

No effect at 4 weeks in 1 trial

Music therapy

3 trials (206 people with no or some agitation)

Reduced in 2 trials

No effect in 1 trial

Reduced at 1 month in 1 trial

Aromatherapy

2 trials (166 people with severe agitation)

Reduced in 1 trial

No effect in 1 trial

Exercise

1 trial (112 people with no agitation)

No effect

No effect at 7 weeks

Simulated presence with recordings of relatives

1 trial (54 people)

No effect

Combinations of interventions

2 trials (151 people with no or some agitation)

No effect in 2 trials

No effect at 2 months in 1 trial

*Most studies compared nondrug interventions with usual care or placebo.

 



Related Topics


Glossary

Placebo
A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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