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Konno R, Kang HS, Makimoto K A best-evidence review of intervention studies for minimizing resistance-to-care behaviours for older adults with dementia in nursing homes Journal of Advanced Nursing. 2014;70(10):2167-80.
What interventions, excluding prescription drugs, effectively manage or reduce resistance-to-care among nursing home residents with dementia?
Many older adults with dementia live in nursing homes and require assistance with personal care.
Resistance to care is common among nursing home residents with dementia, and includes behaviours in which patients prevent or interfere with the staff performing or assisting with the activities of daily living (e.g. bathing, toileting and grooming).
Resistance-to-care is a major barrier to the safety and comfort of older adults with dementia living in nursing homes, creating a source or distress for caregivers which can lead to abusive treatment.
Several electronic databases were searched were records published from 1990 to 2012, and studies were included if they examined approaches (excluding prescription drugs) which aim to reduce resistance-to-care behaviours among adults with dementia who are older than 55 and living in a nursing home.
1,262 studies were identified in searches, and after a detailed review of 103 of the articles, 19 were included in the review.
The authors did not receive any specific funding support to conduct this review.
While all strategies that were evaluated in this review showed some benefit, the evidence was found to be generally weak.
Playing music was the most commonly reported approach aimed at reducing resistance-to-care, and was shown to be successful during mealtime, bath/shower time and in other personal care activities.
Education targeted at nursing-home caregivers to promote person-centred bathing assistance, and to promote basic daily and morning care (e.g. mealtime, grooming, getting dressed) that reflects the abilities of nursing home residents, may be effective, although the evidence is mixed.
While more research is needed to provide strong evidence about strategies to reduce resistance-to-care among older adults with dementia living in nursing homes, playing music appears promising, and person-centred care that reflects the abilities of individuals should be considered.
This summary is based on a review that was determined to be of medium methodological quality based on an assessment using the AMSTAR tool.