Nonpharmacologic Interventions for Care Home Residents With Dementia: Utility of Current Practices

Neuropsychiatric symptoms among people living with a dementia are common and often distressing. Inappropriately treated or untreated symptoms result in unnecessary suffering, 1 Kales H.C. Gitlin L.N. Lyketsos C.G. Assessment and management of behavioral and psychological symptoms of dementia. BMJ. 2015; 350: h369 Crossref PubMed Scopus (488) Google Scholar impaired quality of life, 2 Beerens H.C. Zwakhalen S.M. Verbeek H. et al. Factors associated with quality of life of people with dementia in long-term care facilities: A systematic review. Int J Nurs Stud. 2013; 50: 1259-1270 Crossref PubMed Scopus (122) Google Scholar and immense distress to care home residents and families, 3 Feast A. Orrell M. Charlesworth G. et al. Behavioural and psychological symptoms in dementia and the challenges for family carers: Systematic review. Br J Psychiatry. 2016; 208: 429-434 Crossref PubMed Scopus (77) Google Scholar and their health care providers. 4 Chamberlain S.A. Gruneir A. Hoben M. et al. Influence of organizational context on nursing home staff burnout: A cross-sectional survey of care aides in Western Canada. Int J Nurs Stud. 2017; 71: 60-69 Crossref PubMed Scopus (35) Google Scholar Because neuropsychiatric symptoms are common, care home residents living with dementia may be inappropriately treated with antipsychotic drugs. 5 van der Spek K. Gerritsen D.L. Smalbrugge M. et al. Only 10% of the psychotropic drug use for neuropsychiatric symptoms in patients with dementia is fully appropriate: The PROPER I-study. Int Psychogeriatr. 2016; 28: 1589-1595 Crossref PubMed Scopus (39) Google Scholar Although nonpharmacologic interventions are widely recommended, they are less studied and weakly supported by current evidence. This leaves gaps in understanding and questions about utility. 6 Watt J.A. Goodarzi Z. Veroniki A.A. et al. Comparative efficacy of interventions for aggressive and agitated behaviors in dementia: A systematic review and network meta-analysis. Ann Intern Med. 2019; 171: 633-642 Crossref PubMed Scopus (36) Google Scholar Strategies to manage these burdensome symptoms thus remain suboptimal. Understanding current practices for nonpharmacologic interventions is an important first step to guide testing, implementation, and wider use of such interventions. We (1) identified sensory interventions for reducing neuropsychiatric symptoms and supporting protocols or guidelines currently used in Western Canada and (2) solicited views and opinions on the extent of benefit or harm to care home residents with these interventions.