A systematic review of the literature

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This report should be referenced as follows, Basu A and Brinson D The effectiveness of non pharmacological interventions for. behavioural and psychological symptom management for people with dementia in. residential care settings HSAC Report 2010 3 19, Health Services Assessment Collaboration HSAC University of Canterbury. ISBN 978 0 9864652 1 5 online,ISBN 978 0 9864652 2 2 print. ISSN 1178 5748 online,ISSN 1178 573X print,Review Team. This review was undertaken by the Health Services Assessment Collaboration. HSAC HSAC is a collaboration of the Health Sciences Centre of the University of. Canterbury New Zealand and Health Technology Analysts Sydney Australia This. report was authored by Arindam Basu Senior Researcher and David Brinson. Researcher who jointly developed and undertook the literature search extracted the. data conducted the critical appraisals and prepared the report Sub editing was. performed by Lyn Wright,Acknowledgements, Dr Ray Kirk peer reviewed the final draft Cecilia Tolan Administrator provided.
document formatting Franziska Gallrach Carmel Olsen and staff at the University of. Canterbury Libraries assisted with retrieval of documents. The current review was conducted under the auspices of a contract funded by the New. Zealand Ministry of Health This report was requested by Roz Sorensen Senior. Project Manager Policy and Service Development Mental Health Group Population. Health Directorate of New Zealand s Ministry of Health We thank Roz Sorensen and. Scott Connew Policy Analyst Mental Health Policy and Service Development. Ministry of Health for assisting in developing the scope of the review and providing. background material for the review, A working party steering committee provided advisory input to the review see. Appendix A for membership The systematic review of the evidence will ultimately. be used by the working party steering committee to inform policy decision making in. conjunction with other information The content of the review alone does not. constitute clinical advice or policy recommendations. Acknowledgment is made of the contribution of the internal reference group which. undertook an external peer review of a late draft and provided valuable comments on. the report The Ministry of Health Internal Reference Group membership included. Elizabeth Knopf Joan Mirkin Scott Connew Claire Tennent Roz Sorensen Anne. Bell Anne Foley Catherine Maclean Maria Williamson and Linda Jacobs. Copyright Statement and Disclaimer, This report is copyright Apart from any use as permitted under the Copyright Act. 1994 no part may be reproduced by any process without written permission from. HSAC Requests and inquiries concerning reproduction and rights should be directed. to the Director Health Services Assessment Collaboration Health Sciences Centre. University of Canterbury Private Bag 4800 Christchurch New Zealand. HSAC takes great care to ensure the accuracy of the information in this report but. none of the HSAC the University of Canterbury Health Technology Analysts Pty. Ltd nor the Ministry of Health make any representations or warranties in respect of. the accuracy or quality of the information or accept responsibility for the accuracy. correctness completeness or use of this report, The reader should always consult the original database from which each abstract is. derived along with the original articles before making decisions based on a. The effectiveness of non pharmacological interventions for behavioural and psychological symptom management for. people with dementia in residential care settings, document or abstract All responsibility for action based on any information in this. report rests with the reader, This report is not intended to be used as personal health advice People seeking.
individual medical advice should contact their physician or health professional. The views expressed in this report are those of HSAC and do not necessarily represent. those of the University of Canterbury New Zealand Health Technology Analysts Pty. Ltd Australia or the Ministry of Health,Contact Details. Health Services Assessment Collaboration HSAC,Health Sciences Centre. University of Canterbury,Private Bag 4800,Christchurch 8140. New Zealand,Tel 64 3 345 8147 Fax 64 3 345 8191,Email hsac canterbury ac nz. Web Site www healthsac net, The effectiveness of non pharmacological interventions for behavioural and psychological symptom management for.
people with dementia in residential care settings,Executive Summary. The purpose of this systematic review is to provide a summary of the evidence. pertaining to the relative effectiveness and safety of non pharmacological. interventions for the management of behavioural and psychological symptoms of. dementia BPSD in residential care settings when compared to usual care. The review was requested by the Policy and Service Development team Mental. Health Group Population Health Directorate in the Ministry of Health the Ministry. The content of this evidence review alone does not constitute clinical advice or policy. recommendations The review will inform the Ministry s Mental Health and. Addiction of Older People and Dementia project A working party steering committee. has been convened to lead the project Appendix A and the Health Services. Assessment Collaboration HSAC has been contracted to conduct the systematic. Introduction, Dementia is an acquired deficiency in cognition that impairs successful performance. of the activities in daily living About one in 100 elderly individuals in New Zealand. are diagnosed with dementia and it is projected that by 2026 the age adjusted. prevalence of dementia will be about 1 5 of the population It is estimated that about. 70 of elderly individuals in New Zealand living in residential care facilities show. some form of dementia and as of 2002 the total estimated cost of dementia treatment. in New Zealand was about 713 million dollars, For carers in residential care facilities management of specific behavioural and. psychological symptoms attributed to dementia is important These symptoms are. collectively referred to as BPSD and are defined as patterns of disturbed perception. thought content mood and behaviour that frequently occur in people with dementia. The term BPSD was introduced by the International Psychogeriatrics Association. Task Force at an international meeting in 1986 in order to relate an appropriate term. that could express the complexities of different behavioural and psychological. symptoms associated with dementia While pharmacological interventions have been. used extensively to treat BPSD increasing concerns over their efficacy and significant. side effects have resulted in calls for non pharmacological approaches to be. prioritised as first line interventions Further not all symptoms respond to. pharmacological agents for example behaviours such as wandering social. withdrawal pacing and cognitive deficits and incontinence However the range of. non pharmacological interventions is broad and the evidence base is incomplete. Therefore the purpose of this review is to summarise the effectiveness of different. non pharmacological treatments for the management of BPSD in individuals who are. in residential care facilities, A systematic review was conducted using the following steps First relevant. publications and research reports on the effectiveness of different non. pharmacological treatments aimed at individuals with dementia in residential care. facilities were identified using specific search algorithms for literature retrieval The. literature was searched using the following bibliographic databases MEDLINE. EMBASE PsycINFO CINAHL the Cochrane Database of Systematic Reviews. The effectiveness of non pharmacological interventions for behavioural and psychological symptom management for. people with dementia in residential care settings, CDSR the Database of Abstracts of Reviews of Effects DARE and Database of.
Abstracts of Reviews of Effectiveness Health Technology Assessment database and. the National Guideline Clearing House database were also searched to help identify. existing systematic reviews In addition the bibliographies of included papers were. examined for relevant studies Searches were limited to English language material. published from 1999 to August 2009 inclusive, The comprehensive search process was followed by the critical appraisal of initially. the title and or abstracts and subsequently the full texts of the identified publications. The critical appraisal of literature was undertaken following the Australian National. Health and Medical Research Council NHMRC guidelines using the population. intervention comparator outcomes PICO framework Based on initial appraisals of. the titles and abstracts publications were excluded if they did not meet specific. inclusion criteria Inclusion criteria for this review were publications primary and. secondary research on the effectiveness of non pharmacological interventions. targeted towards individuals who were in residential care facilities with a diagnosis of. dementia non pharmacological intervention studies on humans conducted and. reported in the previously specified ten years 1999 2009 July publications available. in English language or in the form of a reliable pre existing translation and only. outcomes specified as belonging to BPSD were considered ie non cognitive These. BPSD outcomes included but were not limited to agitation aggression mood. disorders and psychosis sexual disinhibition eating problems abnormal. vocalisations sundowning exiting behaviour wandering and or quality of life. scores and or safety related outcomes Studies were excluded from the review if either. the title or the abstract initially did not indicate the nature of the study and did not. meet the inclusion criteria studies were also not considered for review or further. appraisal if full text articles were not available Studies that were single participant. case studies opinions studies published in non standard non peer reviewed. publications such as letters opinions or editorials were also excluded. Systematic reviews randomised controlled trials RCTs and other epidemiological. study designs with appropriate comparison groups were included in the appraisal. process Comparison groups included attention control placebo or usual care In. this review usual care is defined as the care that is normally provided in the study. setting which may or may not include medication for behavioural problems referral. to psychiatric or community mental health services and or any other programmes or. activities ie the absence of a non pharmacological intervention aimed specifically at. treating BPSD The less frequently used and generally more difficult to implement. attention control conditions provide equivalent attention and diversion Examples of. attention controls include a general activity session to control for a specific. intervention activity for example a music therapy activity or a conventional bath to. control for one accompanied by touch massage or music. For each article included in the final appraisal and summary process the key findings. were summarised and the quality of the articles with respect to the rigour with which. the study was conducted was evaluated and possible threats to internal validity were. also considered On the basis of these appraisals the studies were quality evaluated. although in the final appraisal studies were not excluded on the basis of any specified. quality criteria cut off point because of the lack of comparability and diversity of. study designs All study designs except for single case study designs were considered. for the evidence generation Therefore on the basis of gross heterogeneity inherent in. The effectiveness of non pharmacological interventions for behavioural and psychological symptom management for. people with dementia in residential care settings, the review process incorporating many different study types on the same topic no. formal numerical summary or meta analysis was conducted Studies were summarised. based on their design and the evidence,Key results. The search strategy identified a total of 4043 citations of different publication types. These studies included reviews primary studies and other forms of publication. Initial review of the title and abstract of these 4043 studies revealed that 3436 84 9. were either partial or incomplete records or duplicates or not specific to the. population or intervention or outcomes relevant to this review or were publication. types that were not appropriate for inclusion in this review ie they were newsletters. or publications that were neither peer reviewed nor quality assessed or opinion. pieces These publications were not considered further A review of the titles and. abstracts of the remaining 607 studies revealed that 243 40 were ineligible for. full text appraisal because of inappropriate study designs inappropriate population or. inappropriate outcome Further based on full text appraisal of the remaining 364. studies 266 73 1 were excluded The majority of studies deemed ineligible for. this review were excluded because of inappropriate study designs Only well defined. systematic reviews and primary studies that utilised appropriate methodologies were. accepted for inclusion in this review To be considered for inclusion primary research. non pharmacological interventions is broad and the evidence base is incomplete Therefore the purpose of this review is to summarise the effectiveness of different non pharmacological treatments for the management of BPSD in individuals who are in residential care facilities Methods A systematic review was conducted using the following steps First relevant publications and research reports

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