Hostname: page-component-55f67697df-2z2hb Total loading time: 0 Render date: 2025-05-10T10:31:07.889Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychosocial treatments of behavior symptoms in dementia: a systematic review of reports meeting quality standards

Published online by Cambridge University Press:  25 September 2008

Daniel W. O'Connor ,
David Ames ,
Betina Gardner  and
Madeleine King
Daniel W. O'Connor*
Affiliation:
Department of Psychological Medicine, Monash University, Melbourne, Australia
David Ames
Affiliation:
National Ageing Research Institute, University of Melbourne, Melbourne, Australia
Betina Gardner
Affiliation:
Department of Psychological Medicine, Monash University, Melbourne, Australia
Madeleine King
Affiliation:
Centre for Health Economics Research and Evaluation, University of Technology, Sydney, Australia
*
Correspondence should be addressed to: Professor Daniel O'Connor, Aged Mental Health Research Unit, Kingston Centre, Warrigal Road, Cheltenham, Victoria 3192, Australia. Phone: +61 (03) 9265 1700 Fax: +61 (03) 9265 1711. Email: [email protected].
Get access

Abstract

Objective: To provide a systematic review of selected experimental studies of psychosocial treatments of behavioral disturbances in dementia. Psychosocial treatments are defined here as strategies derived from one of three psychologically oriented paradigms (learning theory, unmet needs and altered stress thresholds).

Method: English language reports published or in press by December 2006 were identified by means of database searches, checks of previous reviews and contact with recognized experts. Papers were appraised with respect to study design, participants' characteristics and reporting details. Because people with dementia often respond positively to personal contact, studies were included only if control conditions entailed similar levels of social attention or if one treatment was compared with another.

Results: Only 25 of 118 relevant studies met every specification. Treatment proved more effective than an attention control condition in reducing behavioral symptoms in only 11 of the 25 studies. Effect sizes were mostly small or moderate. Treatments with moderate or large effect sizes included aromatherapy, ability-focused carer education, bed baths, preferred music and muscle relaxation training.

Conclusions: Some psychosocial interventions appear to have specific therapeutic properties, over and above those due to the benefits of participating in a clinical trial. Their effects were mostly small to moderate with a short duration of action. This limited action means that treatments will work best in specific, time-limited situations. In the few studies that addressed within-group differences, there were marked variations in response. Some participants benefited greatly from a treatment, while others did not. Interventions proved more effective when tailored to individuals' preferences.

Keywords

dementiabehaviortreatmentevidencesystematic review
Type
Review Article
Information
International Psychogeriatrics , Volume 21 , Issue 2 , April 2009 , pp. 225 - 240
Copyright
Copyright © International Psychogeriatric Association 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Altman, D. G., Schulz, K. F., Moher, D., Egger, M. and Davidoff, F. (2001). The revised CONSORT statement for reporting randomised trials: explanation and elaboration. Annals of Internal Medicine, 134, 663–694.CrossRefGoogle ScholarPubMed
Ayalon, L., Gum, A. M., Feliciano, L. and Arean, P. A. (2006). Effectiveness of nonpharmacological interventions for the management of neuropsychiatric symptoms in patients with dementia. Archives of Internal Medicine, 166, 2182–2188.CrossRefGoogle ScholarPubMed
Baillon, S., Van Diepen, E., Prettyman, R., Redman, J., Rooke, N. and Campbell, R. (2004). A comparison of the effects of Snoezelen and reminiscence therapy on the agitated behaviour of patients with dementia. International Journal of Geriatric Psychiatry, 19, 1047–1052.CrossRefGoogle Scholar
Baker, R. et al. (2003). Effects of multi-sensory stimulation for people with dementia. Journal of Advanced Nursing, 43, 465–477.CrossRefGoogle ScholarPubMed
Ballard, C. G., O'Brien, J. T., Reichelt, K. and Perry, E. K. (2002). Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: the results of a double-blind, placebo-controlled trial with Melissa. Journal of Clinical Psychiatry, 63, 553–558.CrossRefGoogle ScholarPubMed
Bharani, N. and Snowden, M. (2005). Evidence-based interventions for nursing home residents with dementia-related behavioral symptoms. Psychiatric Clinics of North America, 28, 985–1005.CrossRefGoogle ScholarPubMed
Brodaty, H., Green, A. and Koschera, A. (2003). Meta-analysis of psychosocial interventions for caregivers of people with dementia. Journal of the American Geriatrics Society, 51, 657–664.CrossRefGoogle ScholarPubMed
Burgener, S. C., Jirovec, M., Murrell, L. and Barton, D. (1992). Caregiver and environmental variables related to difficult behaviors in institutionalized, demented elderly persons. Journal of Gerontology, 47, P242–249.CrossRefGoogle ScholarPubMed
Burgio, L., Scilley, K., Hardin, J. M., Hsu, C. and Yancey, J. (1996). Environmental “white noise”: an intervention for verbally agitated nursing home residents. Journal of Gerontology, 51, P364–373.CrossRefGoogle ScholarPubMed
Burgio, L. D., Stevens, A., Burgio, K. L., Roth, D. L., Paul, P. and Gerstle, J. (2002). Teaching and maintaining behavior management skills in the nursing home. Gerontologist, 42, 487–496.CrossRefGoogle ScholarPubMed
Camberg, L. et al. (1999). Evaluation of simulated presence: a personalized approach to enhance well-being in persons with Alzheimer's disease. Journal of the American Geriatrics Society, 47, 446–452.CrossRefGoogle Scholar
Clark, M. E., Lipe, A. W. and Bilbrey, M. (1998). Use of music to decrease aggressive behaviors in people with dementia. Journal of Gerontological Nursing, 24 (7), 10–17.CrossRefGoogle ScholarPubMed
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd edn). Hillsdale, NJ: Lawrence Earlbaum.Google Scholar
Cohen-Mansfield, J. (1986). Agitated behaviours in the elderly II: preliminary results in the cognitively deteriorated. Journal of the American Geriatrics Society, 34, 722–727.Google Scholar
Cohen-Mansfield, J. (1996). Behavioral and mood evaluations: assessment of agitation. International Psychogeriatrics, 8, 233–245.CrossRefGoogle Scholar
Cohen-Mansfield, J. (2001). Nonpharmacologic interventions for inappropriate behaviors in dementia: a review, summary, and critique. American Journal of Geriatric Psychiatry, 9, 361–381.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. and Werner, P. (1997). Management of verbally disruptive behaviours in nursing home residents. Journal of Gerontology, 52A, M369–377.Google Scholar
Cohen-Mansfield, J. and Werner, P. (1998). The effects of an enhanced environment on nursing home residents who pace. Gerontologist, 38, 199–208.CrossRefGoogle ScholarPubMed
De Deyn, P. P., Katz, I. R., Brodaty, H., Lyons, B., Greenspan, A. and Burns, A. (2005). Management of agitation, aggression and psychosis associated with dementia: a pooled analysis including three randomized, placebo-controlled double-blind trials in nursing home residents treated with risperidone. Clinical Neurology and Neurosurgery, 107, 497–508.CrossRefGoogle ScholarPubMed
Dunn, J. C., Thiru-Chelvam, B. and Beck, C. H. M. (2002). Bathing: pleasure or pain? Journal of Gerontological Nursing, 28 (11), 6–13.CrossRefGoogle ScholarPubMed
Forbes, D. A. (1998). Strategies for managing behavioural symptomatology associated with dementia of the Alzheimer type: a systematic overview. Canadian Journal of Nursing Research, 30, 67–86.Google ScholarPubMed
Garland, K., Beer, E., Eppingstall, B. and O'Connor, D. W. (2007). A comparison of two treatments of agitated behavior in nursing home residents with dementia: simulated presence and preferred music. American Journal of Geriatric Psychiatry, 15, 514–521.CrossRefGoogle ScholarPubMed
Gerdner, L. A. (2000). Effects of individualized versus classical “relaxation” music on the frequency of agitation in elderly persons with Alzheimer's disease and related disorders. International Psychogeriatrics, 12, 49–65.CrossRefGoogle ScholarPubMed
Gormley, N., Lyons, D. and Howard, R. (2001). Behavioural management of aggression in dementia: a randomized controlled trial. Age and Ageing, 30, 141–145.Google Scholar
Greve, M. and O'Connor, D. (2005). A survey of Australian and New Zealand old age psychiatrists' preferred medications to treat behavioral and psychological symptoms of dementia. International Psychogeriatrics, 17, 165–178.CrossRefGoogle ScholarPubMed
Groene, R. W. (1993). Effectiveness of music therapy 1:1 intervention with individuals having senile dementia of the Alzheimer's type. Journal of Music Therapy, 30, 138–157.Google Scholar
Hall, G. R. and Buckwalter, K. C. (1987). Progressively lowered stress threshold: a conceptual model for care of adults with Alzheimer's disease. Archives of Psychiatric Nursing, 1, 399–406.Google ScholarPubMed
Haupt, M. and Kurz, A. (1993). Predictors of nursing home placement in patients with Alzheimer's disease. International Journal of Geriatric Psychiatry, 8, 741–746.CrossRefGoogle Scholar
Holmes, C. and Ballard, C. (2004). Aromatherapy in dementia. Advances in Psychiatric Treatment, 10, 296–300.CrossRefGoogle Scholar
Holmes, C., Hopkins, V., Hensford, C., MacLaughlin, V., Wilkinson, D. and Rosenvinge, H. (2002). Lavender oil as a treatment for agitated behaviour in severe dementia: a placebo controlled study. International Journal of Geriatric Psychiatry, 17, 305–308.CrossRefGoogle ScholarPubMed
Kolanowski, A. M., Litaker, M. and Buettner, L. (2005). Efficacy of theory-based activities for behavioral symptoms of dementia. Nursing Research, 54, 219–228.CrossRefGoogle ScholarPubMed
Landreville, P. et al. (2006). Non-pharmacological interventions for aggressive behavior in older adults living in long-term care facilities. International Psychogeriatrics, 18, 47–73.CrossRefGoogle ScholarPubMed
Livingston, G., Johnston, K., Katona, K., Paton, J. and Lyketsos, C. G. (2005). Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia. American Journal of Psychiatry, 162, 1996–2021.CrossRefGoogle Scholar
NH&MRC (2000a). How to review the evidence: systematic identification and review of the scientific literature. Canberra: National Health and Medical Research Council.Google Scholar
NH&MRC (2000b). How to use the evidence: assessment and application of scientific evidence. Canberra: National Health and Medical Research Council.Google Scholar
O'Connor, D. W., Pollitt, P. A., Roth, M., Brook, C. P. B. and Reiss, B. B. (1990). Problems reported by relatives in a community study of dementia. British Journal of Psychiatry, 156, 835–841.CrossRefGoogle Scholar
Opie, J., Rosewarne, R. and O'Connor, D. W. (1999). The efficacy of psychosocial approaches to behaviour disorders in dementia: a systematic literature review. Australian and New Zealand Journal of Psychiatry, 33, 789–799.CrossRefGoogle ScholarPubMed
Opie, J., Doyle, C. and O'Connor, D. W. (2002). Challenging behaviours in nursing home residents with dementia: a randomized controlled trial of multidisciplinary interventions. International Journal of Geriatric Psychiatry, 17, 6–13.CrossRefGoogle ScholarPubMed
Ragneskog, H., Bråne, G., Karlsson, I. and Kihlgren, M. (1996). Influence of dinner music on food intake and symptoms common in dementia. Scandinavian Journal of Caring Sciences, 10, 11–17.CrossRefGoogle ScholarPubMed
Remington, R. (2002). Calming music and hand massage with agitated elderly. Nursing Research, 51, 317–323.CrossRefGoogle ScholarPubMed
Rosnow, R. L. and Rosenthal, R. (1996). Computing contrasts, effect sizes, and counternulls on other people's published data: general procedures for research consumers. Psychological Methods, 1, 331–340.CrossRefGoogle Scholar
Schneider, L. S. et al. (1996). Meta-analysis of controlled pharmacologic trials. International Psychogeriatrics, 8 (Suppl. 3), 375–379.CrossRefGoogle ScholarPubMed
Schneider, L. S. et al. (2006). Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. New England Journal of Medicine, 355, 1525–1538.CrossRefGoogle ScholarPubMed
Sherratt, K., Thornton, A. and Hatton, C. (2004). Emotional and behavioural responses to music in people with dementia: an observational study. Aging and Mental Health, 8, 233–241.CrossRefGoogle ScholarPubMed
Sink, K. M., Holden, K. F. and Yaffe, K. (2005). Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA, 293, 596–608.CrossRefGoogle ScholarPubMed
Sloane, P. D. et al. (2004). Effect of person-centred showering and the towel bath on bathing-associated aggression, agitation, and discomfort in nursing home residents with dementia: a randomized, controlled trial. Journal of the American Geriatrics Society, 52, 1795–1804.CrossRefGoogle Scholar
Snowden, M., Sato, K. and Roy-Byrne, P. (2003). Assessment and treatment of nursing home residents with depression or behavioral symptoms associated with dementia: a review of the literature. Journal of the American Geriatrics Society, 51, 1305–1317.CrossRefGoogle ScholarPubMed
Spira, A. P. and Edelstein, B. A. (2006). Behavioral interventions for agitation in older adults with dementia: an evaluative review. International Psychogeriatrics, 18, 195–225.CrossRefGoogle ScholarPubMed
Suhr, J., Anderson, S. and Tranel, D. (1999). Progressive muscle relaxation in the management of behavioural disturbance in Alzheimer's disease. Neuropsychological Rehabilitation, 9, 31–44.CrossRefGoogle Scholar
Teri, L. et al. (1998). Treatment for agitation in dementia patients: a behavior management approach. Psychotherapy, 35, 436–443.CrossRefGoogle Scholar
Teri, L. et al. (2000). Treatment of agitation in AD: a randomized, placebo-controlled clinical trial. Neurology, 55, 1271–1278.CrossRefGoogle Scholar
Thomas, D. W., Heitman, R. J. and Alexander, T. (1997). The effects of music on bathing cooperation for residents with dementia. Journal of Music Therapy, 34, 246–259.CrossRefGoogle Scholar
Toseland, R. W., Diehl, M., Freeman, K., Manzanares, T., Naleppa, M. and McCallion, P. (1997). The impact of validation group therapy on nursing home residents with dementia. Journal of Applied Gerontology, 16, 31–50.CrossRefGoogle Scholar
Turner, S. (2004). Behavioural symptoms of dementia in residential settings: a selective review of non-pharmacological interventions. Aging and Mental Health, 9, 93–104.Google Scholar
Verkaik, R, Van Weert, J. C. M. and Francke, A. L. (2005). The effects of psychosocial methods on depressed, aggressive and apathetic behaviors of people with dementia: a systematic review. International Journal of Geriatric Psychiatry, 20, 301–314.CrossRefGoogle ScholarPubMed
Wells, D. L., Dawson, P., Sidani, S., Craig, D. and Pringle, D. (2000). Effects of an abilities-focused program of morning care on residents who have dementia and on caregivers. Journal of the American Geriatrics Society, 48, 442–449.Google ScholarPubMed