Our Team Non-Pharmacological Approaches to Address Behaviors This section of the Toolkit contains a literature review on non-pharmacological approaches NPA most effective in reducing the behavioral and psychological symptoms of distress BPSD exhibited by persons with dementia residing in nursing homes. NPA are the first-line therapy for responding to BPSD due to the high risks and limited effectiveness of antipsychotic medications for treating these symptoms. As a result, there is an urgent need to equip nursing home providers with readily accessible tools for identifying and implementing NPA. After presenting information that will help staff understand BPSD, practical guidance for providers, lessons learned from the field i.
This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Behavioral and psychological symptoms of dementia BPSD are defined as a group of symptoms of disturbed perceptive thought content, mood, or behavior that include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, and wandering.
Care of patients with BPSD involves pharmacological and nonpharmacological interventions. We reviewed studies of nonpharmacological interventions published in the last 10 years. We performed a systematic review in Medline and Embase databases, in the last 10 years, until June Key words used were 1 non-pharmacological interventions, 2 behavioral symptoms, 3 psychological symptoms, and 4 dementia.
We included 20 studies published in this period. Among these studies, program activities were more frequent five studies and the symptoms more responsive to the interventions were agitation. Studies are heterogeneous in many aspects, including size sample, intervention, and instruments of measures.
Nonpharmacological interventions are able to provide positive results in reducing symptoms of BPSD. Most studies have shown that these interventions have important and significant efficacy. BPSD include many different behaviors such as screaming disruptive vocalizationrestlessness, repetitive questions, wandering, and apathy.
As dementia is a progressive disease, BPSD worsen over time, requiring higher support and increasing cost of care [ 5 ]. BPSD have been associated with a poorer prognosis, a more rapid rate of cognitive decline, and illness progression [ 6 ], greater impairment in activities of daily living ADLs [ 6 ], and increased institutionalization at hospitals or residential care facilities [ 27 ].
The frequency and severity of these symptoms have been strongly correlated with caregiver burden, reducing quality of life of patients and their caregivers [ 8 ].
Psychotropic medications have modest efficacy and can lead to undesired side effects [ 9 — 11 ] but they are frequently used to treat BPSD [ 12 — 15 ]. According to Cohen-Mansfield [ 19 ] most professionals have some training in medication prescription for BPSD, but few are instructed about nonpharmacological interventions or receive information about their effectiveness.
As a consequence, antipsychotics drugs are frequently prescribed before alternative nonpharmacological approaches are attempted, and patients are maintained in medication for long periods, which leads to increasing morbidity and mortality.
This scenario may be improved if professionals involved in dementia care are better apprised of the indications and limitations for the several existing nonpharmacological therapies for BPSD. Some studies have shown that nonpharmacological treatments pose fewer side effects, which render them as safer options [ 20 ].
Nonpharmacological alternatives, including music therapy, aromatherapy, art therapy, behavioral therapy, reality orientation, tailored activities, and physical exercises, have shown promising results for the management of BPSD [ 21 — 23 ].
The aim of the present review was to identify and summarize the main nonpharmacological interventions for BPSD in the treatment of patients with dementia published in the last ten years. Literature Review We systematically searched the Medline and Embase databases using the following keywords: These terms were selected even in the absence of specific Mesh terms as to increase sensitivity.
The date limits ranged from the first paper published in to June We also looked for reviews to identify relevant articles about the issue. Eligibility Criteria To be included in the review, papers had to be written in English, Spanish, or Portuguese and have appropriate description of the study design e.
Systematic reviews, meta-analyses, case reports, and editorial letters were not included in our review. After selection and analysis of papers according to the above-mentioned inclusion criteria, the following variables were extracted and organized: A critical analysis was performed in order to investigate the response of patients presenting diverse symptoms of BPSD to different nonpharmacological approaches.
Results Our initial search returned 33 references. Of these, 20 studies met the inclusion criteria and were included in our review: A brief comment and critical overview on selected studies is presented as follows.
Summary of nonpharmacological interventions studies to reduce behavioral and psychological symptoms of dementia BPSD. Occupational Activities The use of activities as nonpharmacological intervention for people with dementia has shown potential benefits in quality of life and in reducing agitation and depression [ 37 — 39 ].
TAP is an occupational therapy intervention program that focuses on reducing undesirable behaviors associated with dementia [ 28 ]. The program also offers training for caregivers in order to simplify activities and to adapt them for future functional declines of the patient as well as to generalize strategies to other contexts, thus helping caregivers to develop an increased sense of self-efficacy.
We found four studies about the effectiveness of music therapy for the management of BPSD. One investigated the effects of two interventions, simulated family presence and preferred music, where participants were exposed to minute audiotape sessions.Apathy after acquired brain impairment: A systematic review of non-pharmacological interventions A.
T. Lane-Brown Rehabilitation Studies Unit, University of Sydney, Australia and Royal Rehabilitation Centre, Sydney, Australia Correspondence [email protected] The non-pharmacologic interventions addressed in this review have a low incidence of harms.
We will use reported harms from RCTs, and prospective and retrospective cohort studies in persons with dementia.
The guidelines by Doody et al provide an excellent review of the current literature on the use of pharmacological and non-pharmacological (including educational) interventions for the management of AD. Furthermore, the authors offer sensible recommendations for future research. interventions for the management of delirium itself.
There is little evidence from experimental studies on the effectiveness of non-pharmacological interventions on the management of delirium. Non-pharmacological approaches to dementia: An overview of foundations & considerations Dementia is a syndrome characterized by the progressive degeneration of one's cognitive function.
The syndrome inflicts one in every nine individuals 65 and older; and , individuals under the age of Evidence-Based Systematic Review of Efficacious Interventions. AUTHORS: Nursing interventions targeting behavioral, safety, and effectiveness of non-pharmacological interventions.
Table 1. Non-pharmacological delirium interventions supported in the literature.