Non-pharmacological interventions for aggression in persons with dementia: A review of the literature.

Abstract

The term "dementia" refers to decline in a number of cognitive abilities such as attention, language and memory that negatively interferes with daily functioning (APA, 2000). Dementia can be caused by many different conditions, some of which are reversible (e.g., vitamin B12 deficiencies, dehydration, adverse reactions to medications) and some that are not reversible (e.g., Alzheimer's disease, vascular dementia, frontotemporal dementia). In cases where dementia is irreversible, behavioral disturbances are common, particularly as the disease becomes more severe. Although behavioral disturbances come in many different varieties, verbal and physical aggression presents one of most the challenging and dangerous situations faced by caregivers. The purpose of this paper is to describe the problem of aggression, review the empirical literature investigating nonpharmacological interventions for managing aggressive behavior, and provide suggestions for future research.

Non-pharmacological interventions for aggression in persons with dementia: A 10-year follow-up review of the literature

“…Three studies investigating distraction-based interventions support conclusions drawn from previous reviews [29] suggesting that this intervention approach may be particularly promising for reducing aggression during ADLs. The strength of this approach is that the rationale behind it is straightforward and it requires less training time compared to the comprehensive training approaches described earlier.…”

“…The four studies reviewed that implement this approach produced mixed results, with three finding no effect [31,33,36] and one finding a significant effect. [34] Similar conclusions were made by Buchanan and colleagues [29] regarding "activitybased interventions" such as walking groups, music therapy, social gatherings, night-time spa baths, or swinging. Overall, the approach of simply increasing various kinds of activity or introducing novel stimuli into the living environment has had limited impact on aggression.…”

“…The following sections will revisit limitations in the literature identified by Buchanan et al [29] to determine the extent to which these limitations have been addressed in the past decade.…”

“…[29] Given that aggression is highly prevalent, results in many negative consequences, and the continued push to reduce antipsychotic use, an updated review of the literature on non-pharmacological interventions appeared warranted. Therefore, the current paper represents a 10-year follow-up to Buchanan and colleagues' 2007 literature review and has three primary purposes: (1) To update the review of the empirical literature in this area; (2) To examine how limitations in the literature have been addressed over the past 10 years; and (3) To suggest areas of future inquiry.…”

“…These interventions are based on the premise that these activities will have a general calming influence on PWDs, resulting in a more specific effect such as reducing aggression. This category of interventions is similar to the category of "activity-based interventions" described by Buchanan and colleagues, [29] which included a variety of interventions that involved incorporating activities (e.g., spa baths, swinging on gliders, walking, music therapy) into the day-to-day life of PWDs with the goal of impacting aggression.…”