Exploring Factors Associated With Successful Nonpharmacological Interventions for People With Dementia

Abstract

Background and purpose We investigated existing nonpharmacological programs for people with dementia (PWD) to explore critical factors related to the effectiveness of these types of programs. Methods We conducted a qualitative systematic literature review to identify nonpharmacological intervention programs developed for PWD and reviewed 36 randomized controlled trials. Among several outcomes reported in each study, we focused on the most common outcomes including quality of life (QoL), neuropsychiatric symptoms, depression, agitation, and cognition for further review. Results Several factors were identified that might affect the outcomes of nonpharmacological interventions for PWD including study design, characteristics of the intervention, maintaining research participants, heterogeneity issues, and implementation fidelity. About half of studies in this review reported positive program effects on their targeted outcomes such as Well-being and Health for PWD on improving quality of life, neuropsychiatric symptoms and agitation; cognitive stimulation therapy on QoL, neuropsychiatric symptoms and cognition; and a stepwise multicomponent intervention on neuropsychiatric symptoms, depression and agitation. Conclusions We found some programs even with a rigorous study design did not produce expected outcomes while other programs with poor designs reported positive outcomes, which necessitates further investigation on the validity of the assessments. Factors such as individual tailored and customized interventions, promoting social interactions, ease of administration and compatibility of interventions, and developing program theory need to be considered when developing nonpharmacological intervention programs.

Unter welchen Bedingungen können Menschen mit schwerer Demenz im Pflegeheim von einer psychosozialen Mehrkomponenten-Intervention profitieren?

“…In der DeTaMAKS-Studie, in der Menschen mit leichter oder mittlerer Demenz in der Tagespflege untersucht wurden, zeigte sich in der offenen Studienphase, in der die Intervention nicht mehr unter kontrollierten Bedingungen durchgeführt wurde (alle Einrichtungen waren geschult, die Anwendung der Intervention war freigestellt), eine geringere Effektstärke als während der kontrollierten Phase [13,14]. Auch andere Studien zeigten, dass die Wirksamkeit einer Intervention substanziell von der "ordnungsgemäßen" Durchführung der Maßnahme beeinflusst wird [15]. Manualtreue, das heißt, dass eine Intervention exakt nach Vorgabe des Manuals durchgeführt wird, scheint somit einen nicht unerheblichen Einfluss auf die Wirkung einer Intervention zu haben.…”

“…The open study phase means that the intervention was no longer carried out under controlled conditions (all facilities were trained, the application of the intervention was optional). Other studies have also shown that the effectiveness of an intervention is substantially influenced by the "proper" implementation of the intervention [15]. Therapy fidelity (i. e. when an intervention is carried out in exact accordance with the manual) thus seems to have a significant influence on the effect of an intervention.…”