Effects of nonpharmacological interventions on functioning of people living with dementia at home: A systematic review of randomised controlled trials

Iona Scott; Claudia Cooper; Monica Leverton; Alex Burton; Jules Beresford-Dent; Kenneth Rockwood; Laurie Butler; Penny Rapaport

doi:10.1002/gps.5127

Effects of nonpharmacological interventions on functioning of people living with dementia at home: A systematic review of randomised controlled trials

Iona Scott, Claudia Cooper^*, Monica Leverton, Alex Burton, Jules Beresford-Dent, Kenneth Rockwood, Laurie Butler, Penny Rapaport

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

19 Citations (Scopus)

Abstract

Objective: Slowing functional decline could enable people living with dementia to live for longer and more independently in their own homes. We aimed to update previous syntheses examining the effectiveness of nonpharmacological interventions in reducing functional decline (activities of daily living, activity-specific physical functioning, or function-specific goal attainment) in people living in their own homes with dementia. Methods: We systematically searched electronic databases from January 2012 to May 2018; two researchers independently rated risk of bias of randomised controlled trials (RCTs) fitting predetermined inclusion criteria using a checklist; we narratively synthesised findings, prioritising studies judged to have a lower risk of bias. Results: Twenty-nine papers (describing 26 RCTs) met eligibility criteria, of which we judged 13 RCTs to have a lower risk of bias. Study interventions were evaluated in four groups: physical exercise, occupational, multicomponent, and cognition-oriented interventions. Four out of 13 RCTs reported functional ability as a primary outcome. In studies judged to have a lower risk of bias, in-home tailored exercise, individualised cognitive rehabilitation, and in-home activities-focussed occupational therapy significantly reduced functional decline relative to control groups in individual studies. There was consistent evidence from studies at low risk of bias that group-based exercise and reminiscence therapies were ineffective at reducing functional decline. Conclusion: We found no replicated evidence of intervention effectiveness in decreasing functional decline. Interventions associated with slower functional decline in individual trials have been individually delivered and tailored to the needs of the person with dementia. This is consistent with previous findings. Future intervention trials should prioritise these approaches.

Original language	English
Pages (from-to)	1386-1402
Number of pages	17
Journal	International Journal of Geriatric Psychiatry
Volume	34
Issue number	10
DOIs	https://doi.org/10.1002/gps.5127
Publication status	Published - 1 Oct 2019

Keywords

activities of daily living
community care
dementia
function

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title = "Effects of nonpharmacological interventions on functioning of people living with dementia at home: A systematic review of randomised controlled trials",

abstract = "Objective: Slowing functional decline could enable people living with dementia to live for longer and more independently in their own homes. We aimed to update previous syntheses examining the effectiveness of nonpharmacological interventions in reducing functional decline (activities of daily living, activity-specific physical functioning, or function-specific goal attainment) in people living in their own homes with dementia. Methods: We systematically searched electronic databases from January 2012 to May 2018; two researchers independently rated risk of bias of randomised controlled trials (RCTs) fitting predetermined inclusion criteria using a checklist; we narratively synthesised findings, prioritising studies judged to have a lower risk of bias. Results: Twenty-nine papers (describing 26 RCTs) met eligibility criteria, of which we judged 13 RCTs to have a lower risk of bias. Study interventions were evaluated in four groups: physical exercise, occupational, multicomponent, and cognition-oriented interventions. Four out of 13 RCTs reported functional ability as a primary outcome. In studies judged to have a lower risk of bias, in-home tailored exercise, individualised cognitive rehabilitation, and in-home activities-focussed occupational therapy significantly reduced functional decline relative to control groups in individual studies. There was consistent evidence from studies at low risk of bias that group-based exercise and reminiscence therapies were ineffective at reducing functional decline. Conclusion: We found no replicated evidence of intervention effectiveness in decreasing functional decline. Interventions associated with slower functional decline in individual trials have been individually delivered and tailored to the needs of the person with dementia. This is consistent with previous findings. Future intervention trials should prioritise these approaches.",

keywords = "activities of daily living, community care, dementia, function",

author = "Iona Scott and Claudia Cooper and Monica Leverton and Alex Burton and Jules Beresford-Dent and Kenneth Rockwood and Laurie Butler and Penny Rapaport",

note = "Funding Information: This work was carried out within the UCL Alzheimer's Society Centre of Excellence for Independence at home, NIDUS (New Interventions in Dementia Study) programme (Alzheimer's Society Centre of Excellence grant 330). Publisher Copyright: {\textcopyright} 2019 John Wiley & Sons, Ltd.",

year = "2019",

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Scott, I, Cooper, C, Leverton, M, Burton, A, Beresford-Dent, J, Rockwood, K, Butler, L & Rapaport, P 2019, 'Effects of nonpharmacological interventions on functioning of people living with dementia at home: A systematic review of randomised controlled trials', International Journal of Geriatric Psychiatry, vol. 34, no. 10, pp. 1386-1402. https://doi.org/10.1002/gps.5127

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T1 - Effects of nonpharmacological interventions on functioning of people living with dementia at home

T2 - A systematic review of randomised controlled trials

AU - Scott, Iona

AU - Cooper, Claudia

AU - Leverton, Monica

AU - Burton, Alex

AU - Beresford-Dent, Jules

AU - Rockwood, Kenneth

AU - Butler, Laurie

AU - Rapaport, Penny

N1 - Funding Information: This work was carried out within the UCL Alzheimer's Society Centre of Excellence for Independence at home, NIDUS (New Interventions in Dementia Study) programme (Alzheimer's Society Centre of Excellence grant 330). Publisher Copyright: © 2019 John Wiley & Sons, Ltd.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Objective: Slowing functional decline could enable people living with dementia to live for longer and more independently in their own homes. We aimed to update previous syntheses examining the effectiveness of nonpharmacological interventions in reducing functional decline (activities of daily living, activity-specific physical functioning, or function-specific goal attainment) in people living in their own homes with dementia. Methods: We systematically searched electronic databases from January 2012 to May 2018; two researchers independently rated risk of bias of randomised controlled trials (RCTs) fitting predetermined inclusion criteria using a checklist; we narratively synthesised findings, prioritising studies judged to have a lower risk of bias. Results: Twenty-nine papers (describing 26 RCTs) met eligibility criteria, of which we judged 13 RCTs to have a lower risk of bias. Study interventions were evaluated in four groups: physical exercise, occupational, multicomponent, and cognition-oriented interventions. Four out of 13 RCTs reported functional ability as a primary outcome. In studies judged to have a lower risk of bias, in-home tailored exercise, individualised cognitive rehabilitation, and in-home activities-focussed occupational therapy significantly reduced functional decline relative to control groups in individual studies. There was consistent evidence from studies at low risk of bias that group-based exercise and reminiscence therapies were ineffective at reducing functional decline. Conclusion: We found no replicated evidence of intervention effectiveness in decreasing functional decline. Interventions associated with slower functional decline in individual trials have been individually delivered and tailored to the needs of the person with dementia. This is consistent with previous findings. Future intervention trials should prioritise these approaches.

AB - Objective: Slowing functional decline could enable people living with dementia to live for longer and more independently in their own homes. We aimed to update previous syntheses examining the effectiveness of nonpharmacological interventions in reducing functional decline (activities of daily living, activity-specific physical functioning, or function-specific goal attainment) in people living in their own homes with dementia. Methods: We systematically searched electronic databases from January 2012 to May 2018; two researchers independently rated risk of bias of randomised controlled trials (RCTs) fitting predetermined inclusion criteria using a checklist; we narratively synthesised findings, prioritising studies judged to have a lower risk of bias. Results: Twenty-nine papers (describing 26 RCTs) met eligibility criteria, of which we judged 13 RCTs to have a lower risk of bias. Study interventions were evaluated in four groups: physical exercise, occupational, multicomponent, and cognition-oriented interventions. Four out of 13 RCTs reported functional ability as a primary outcome. In studies judged to have a lower risk of bias, in-home tailored exercise, individualised cognitive rehabilitation, and in-home activities-focussed occupational therapy significantly reduced functional decline relative to control groups in individual studies. There was consistent evidence from studies at low risk of bias that group-based exercise and reminiscence therapies were ineffective at reducing functional decline. Conclusion: We found no replicated evidence of intervention effectiveness in decreasing functional decline. Interventions associated with slower functional decline in individual trials have been individually delivered and tailored to the needs of the person with dementia. This is consistent with previous findings. Future intervention trials should prioritise these approaches.

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SN - 0885-6230

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EP - 1402

JO - International Journal of Geriatric Psychiatry

JF - International Journal of Geriatric Psychiatry

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ER -

Effects of nonpharmacological interventions on functioning of people living with dementia at home: A systematic review of randomised controlled trials

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