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In people with dementia who live in long-term care, sensory stimulation or a multistep program improves some behaviours

Zimmerman S, Anderson WL, Brode S, et al. Systematic review: Effective characteristics of nursing homes and other residential long-term care settings for people with dementia. J Am Geriatr Soc. 2013;61:1399-409.

Review question

In people with dementia who live in long-term care homes (e.g., nursing homes or assisted living homes that provide support for doing everyday things, such as eating and getting around), what programs improve health and other outcomes?

Background

Dementia includes problems with thinking, memory, language and judgment that are noticeable and affect daily living. Dementia gets worse over time and can eventually affect a person’s ability to do everyday things, such as bathing, eating and moving about.

People living in long-term care homes typically get help with their personal care. The level of help varies in different types of homes and ranges from help with everyday living activities, such as bathing and taking medication, to 24-hour nursing care.

Long-term care homes may use programs to help reduce some of the symptoms (e.g., poor memory) or difficult behaviours (e.g., restlessness or aggression) associated with dementia.

How the review was done

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

They found 9 randomized controlled trials, each with at least 30 people, and 5 non-randomized studies.

The key features of the randomized controlled trials were:

  • people had a diagnosis of dementia or symptoms or signs of dementia;
  • programs were done in nursing homes, assisted living homes, or special care units for dementia in the USA;
  • programs included bright light therapy; pleasant sensory stimulation (e.g., calm music or hand massage); functional skills training including practice of everyday activities; creative expression storytelling using pictures and questions to encourage sharing; validation therapy, which acknowledges the feelings and behaviours of people with dementia and includes ways to communicate with them; a multistep program for assessing and managing discomfort and behaviour; and a program to support bathing; and
  • most programs were compared with usual care.

What the researchers found

All studies were rated as fair or good quality. Selected findings from the randomized controlled trials are reported in the table.

Conclusion

In people with dementia who live in long-term care, small trials suggest that pleasant sensory stimulation reduces agitation, and multistep and bathing support programs reduce pain and discomfort and improve some behaviours.

Nursing or long-term care home programs vs usual care in people with dementia*

Programs

Number of trials (people)

Effects of programs

Bright light therapy in the morning

2 trials (201 people)

Increased depressive symptoms in men but not women in 1 trial

No effect for sleep quality in 1 trial

Pleasant sensory stimulation (calm music or hand massage)

1 trial (68 people)

Hand massage, with or without calm music, reduced agitation

Functional skills training with practice of everyday activities such as getting around

1 trial (63 people)

Reduced need for assistance with everyday activities

Creative expression storytelling using pictures and questions

1 trial (number of people not reported)

Made people more alert and engaged but increased anxiety, sadness and behavioral symptoms

Validation therapy, including ways to communicate with people with dementia

1 trial (88 people)

Reduced some measures of physical and verbal aggression but not others

Increased some measures of problem behaviours (e.g., restlessness, pacing)

No effect on use of psychoactive drugs

Individualized multistep program to assess and manage discomfort and behavior†

1 trial (114 people)

Reduced pain and discomfort and improved behaviour symptoms

Support for bathing

1 trial (73 people)

Reduced pain and discomfort, agitation and aggression

*The study of pleasant sensory stimulation had a moderate strength of evidence; all other studies had low or insufficient strength of evidence.

†Program was compared with an education intervention.




Glossary

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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DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

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