Hostname: page-component-745bb68f8f-f46jp Total loading time: 0 Render date: 2025-01-11T18:47:54.026Z Has data issue: false hasContentIssue false
  • English
  • Français

Systematic review of the effectiveness of non-pharmacological interventions to improve quality of life of people with dementia

Published online by Cambridge University Press:  16 January 2012

Claudia Cooper ,
Naaheed Mukadam ,
Cornelius Katona ,
Constantine G. Lyketsos ,
David Ames ,
Peter Rabins ,
Knut Engedal ,
Carlos de Mendonça Lima ,
Dan Blazer  and
Linda Teri
...Show all authors
Claudia Cooper*
Affiliation:
University College London, London, UK
Naaheed Mukadam
Affiliation:
University College London, London, UK
Cornelius Katona
Affiliation:
University College London, London, UK
Constantine G. Lyketsos
Affiliation:
Department of Psychiatry, Johns Hopkins Medicine, The Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
David Ames
Affiliation:
National Ageing Research Institute, Parkville, Victoria, Australia University of Melbourne, Victoria, Australia
Peter Rabins
Affiliation:
Department of Psychiatry, Johns Hopkins Medicine, The Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
Knut Engedal
Affiliation:
Oslo University Hospital, Nydalen, Oslo, Norway
Carlos de Mendonça Lima
Affiliation:
Centro Hospitalar do Alto Ave, Rua dos Cutileiros, GUIMARÃES, Portugal
Dan Blazer
Affiliation:
Duke University Medical Center, Durham, NC, USA
Linda Teri
Affiliation:
University of Washington, Seattle, WA, USA
Henry Brodaty
Affiliation:
National Ageing Research Institute, Parkville, Victoria, Australia University of Melbourne, Victoria, Australia
Gill Livingston
Affiliation:
University College London, London, UK
*
Correspondence should be addressed to: Dr. Claudia Cooper, Department of Mental Health Sciences, University College London, Holborn Union Building, Archway Campus, Highgate Hill, London, N19 5LW, UK. Phone: +0207 288 5931; Fax: +0207 288 3411. Email: c.cooper@ucl.ac.uk.
Get access

Abstract

Background: People with dementia report lower quality of life, but we know little about what interventions might improve it.

Methods: We systematically reviewed 20 randomized controlled trials reporting the effectiveness of non-pharmacological interventions in improving quality of life or well-being of people with dementia meeting predetermined criteria. We rated study validity with a checklist. We contacted authors for additional data. We calculated standardized mean differences (SMD) and, for studies reporting similar interventions, pooled standardized effect sizes (SES).

Results: Pooled analyses found that family carer coping strategy-based interventions (four studies, which did not individually achieve significance; n = 420; SES 0.24 (range 0.03–0.45)) and combined patient activity and family carer coping interventions (two studies, not individually significant; n = 191; SES 0.84 (range 0.54–1.14)) might improve quality of life. In one high-quality study, a care management system improved quality of life of people with dementia living at home. Group Cognitive Stimulation Therapy (GCST) improved quality of life of people with dementia in care homes.

Conclusion: Preliminary evidence indicated that coping strategy-based family carer therapy with or without a patient activity intervention improved quality of life of people with dementia living at home. GCST was the only effective intervention in a higher quality trial for those in care homes, but we did not find such evidence in the community. Few studies explored whether effects continued after the intervention stopped. Future research should explore the longer-term impact of interventions on, and devise strategies to increase, life quality of people with dementia living in care homes or at home without a family carer.

Keywords

well-beingsystematic reviewmeta-analysiscontrolled trial
Type
Review Article
Information
International Psychogeriatrics , Volume 24 , Issue 6 , June 2012 , pp. 856 - 870
Copyright
Copyright © International Psychogeriatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Albert, S. M. et al. (1996). Quality of life in patients with Alzheimer's disease as reported by patient proxies. Journal of the American Geriatrics Society, 44, 1342–1347.CrossRefGoogle ScholarPubMed
Ballard, C. G., O'Brien, J. T., Reichelt, K. and Perry, E. K. (2002). Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: the results of a double-blind, placebo-controlled trial with Melissa. Journal of Clinical Psychiatry, 63, 553–558.CrossRefGoogle ScholarPubMed
Banerjee, S., Smith, S., Lamping, D., Foley, B., Smith, P. and Murray, J. (2004). DEMQOL – evaluation of a new system for measuring quality of life in people with dementia: validity, reliability and use in regular practice. Neurobiology of Aging, 25, S321.CrossRefGoogle Scholar
Black, B. S. and Rabins, P. V. (2010). Quality of life in dementia: conceptual and practice issues. In Ames, D., O'Brien, J. and Burns, A. (eds.), Dementia (pp. 293–304). London: Hodder Arnold.Google ScholarPubMed
Burns, A. et al. (2011). A double-blind placebo-controlled randomized trial of Melissa officinalis oil and donepezil for the treatment of agitation in Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 31, 158–164.CrossRefGoogle ScholarPubMed
Chapman, S. B., Weiner, M. F., Rackley, A., Hynan, L. S. and Zientz, J. (2004). Effects of cognitive-communication stimulation for Alzheimer's disease patients treated with donepezil. Journal of Speech, Language, and Hearing Research, 47, 1149–1163.CrossRefGoogle ScholarPubMed
Chenoweth, L. et al. (2009). Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial. Lancet Neurology, 8, 317–325.CrossRefGoogle ScholarPubMed
Christensen, K., Doblhammer, G., Rau, R. and Vaupel, J. W. (2009). Ageing populations: the challenges ahead. Lancet, 374, 1196–1208.CrossRefGoogle ScholarPubMed
Clare, L. et al. (2010). Goal-oriented cognitive rehabilitation for people with early-stage Alzheimer disease: a single-blind randomized controlled trial of clinical efficacy. American Journal of Geriatric Psychiatry, 18, 928–939.CrossRefGoogle ScholarPubMed
Cooper, C., Bebbington, P., Katona, C. and Livingston, G. (2009). Successful aging in health adversity: results from the National Psychiatric Morbidity Survey. International Psychogeriatrics, 21, 861–868.CrossRefGoogle ScholarPubMed
Cooper, C. et al. (2011). A systematic review of treatments for refractory depression in older people. American Journal of Psychiatry, 168, 681–688.CrossRefGoogle ScholarPubMed
Cordner, Z., Blass, D. M., Rabins, P. V. and Black, B. S. (2010). Quality of life in nursing home residents with advanced dementia. Journal of the American Geriatrics Society, 58, 2394–2400.CrossRefGoogle ScholarPubMed
Davis, R. N., Massman, P. J. and Doody, R. S. (2001). Cognitive intervention in Alzheimer disease: a randomized placebo-controlled study. Alzheimer Disease and Associated Disorders, 15, 1–9.CrossRefGoogle ScholarPubMed
Egger, M., Smith, G. D., Schneider, M. and Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal, 315, 629–634.CrossRefGoogle ScholarPubMed
Ferri, C. P. et al. (2005). Global prevalence of dementia: a Delphi consensus study. Lancet, 366, 2112–2117.CrossRefGoogle ScholarPubMed
Gallagher-Thompson, D., Arean, P., Rivera, P. and Thompson, L. (2001). A psychoeducational intervention to reduce distress in Hispanic family caregivers: results of a pilot study. Clinical Gerontologist, 23, 17–32.CrossRefGoogle Scholar
Gavrilova, S. I., Ferri, C. P., Mikhaylova, N., Sokolova, O., Banerjee, S. and Prince, M. (2009). Helping carers to care: the 10/66 dementia research group's randomized control trial of a caregiver intervention in Russia. International Journal of Geriatric Psychiatry, 24, 347–354.CrossRefGoogle ScholarPubMed
Gitlin, L. N., Winter, L., Burke, J., Chernett, N., Dennis, M. P. and Hauck, W. W. (2008). Tailored activities to manage neuropsychiatric behaviors in persons with dementia and reduce caregiver burden: a randomized pilot study. American Journal of Geriatric Psychiatry, 16, 229–239.CrossRefGoogle ScholarPubMed
Gitlin, L. N., Winter, L., Dennis, M. P., Hodgson, N. and Hauck, W. W. (2010). A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: the COPE randomized trial. JAMA, 304, 983–991.CrossRefGoogle ScholarPubMed
Graff, M. J., Vernooij-Dassen, M. J., Thijssen, M., Dekker, J., Hoefnagels, W. H. and Olderikkert, M. G. (2007). Effects of community occupational therapy on quality of life, mood, and health status in dementia patients and their caregivers: a randomized controlled trial. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 62, 1002–1009.CrossRefGoogle ScholarPubMed
Guerra, M., Ferri, C. P., Fonseca, M., Banerjee, S. and Prince, M. (2010). Helping carers to care: the 10/66 dementia research group's randomized control trial of a caregiver intervention in Peru. Revista Brasileira de Psiquiatria, 33, 47–54.CrossRefGoogle ScholarPubMed
Hoe, J., Katona, C., Roch, B. and Livingston, G. (2005). Use of the QOL-AD for measuring quality of life in people with severe dementia: the LASER-AD study. Age and Ageing, 34, 130–135.CrossRefGoogle ScholarPubMed
Hoe, J., Hancock, G., Livingston, G. and Orrell, M. (2006). Quality of life of people with dementia in residential care homes. British Journal of Psychiatry, 188, 460–464.CrossRefGoogle ScholarPubMed
Hoe, J., Katona, C., Orrell, M. and Livingston, G. (2007). Quality of life in dementia – care recipient and caregiver perceptions of quality of life in dementia: the LASER-AD study. International Journal of Geriatric Psychiatry, 22, 1031–1036.CrossRefGoogle ScholarPubMed
Hoe, J., Hancock, G., Livingston, G., Woods, B., Challis, D. and Orrell, M. (2009). Changes in the quality of life of people with dementia living in care homes. Alzheimer Disease and Associated Disorders, 23, 285–290.CrossRefGoogle ScholarPubMed
Lai, C. K., Chi, I. and Kayser-Jones, J. (2004). A randomized controlled trial of a specific reminiscence approach to promote the well-being of nursing home residents with dementia. International Psychogeriatrics, 16, 33–49.CrossRefGoogle ScholarPubMed
Livingston, G., Johnston, K., Katona, C., Paton, J. and Lyketsos, C. G. (2005). Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia. American Journal of Psychiatry, 162, 1996–2021.CrossRefGoogle Scholar
Livingston, G., Cooper, C., Woods, J., Milne, A. and Katona, C. (2008). Successful ageing in adversity: the LASER-AD longitudinal study. Journal of Neurology, Neurosurgery and Psychiatry, 79, 641–645.CrossRefGoogle ScholarPubMed
Logsdon, R., Gibbons, L. E. and McCurry, S. M. (1996). Quality of life in Alzheimer's disease: patient and caregiver reports. Journal of Mental Health and Aging, 5, 21–32.Google Scholar
Logsdon, R. G. et al. (2010). Early-stage memory loss support groups: outcomes from a randomized controlled clinical trial. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 65, 691–697.CrossRefGoogle ScholarPubMed
Meguro, M., Kasai, M., Akanuma, K., Ishii, H., Yamaguchi, S. and Meguro, K. (2008). Comprehensive approach of donepezil and psychosocial interventions on cognitive function and quality of life for Alzheimer's disease: the Osaki-Tajiri project. Age and Ageing, 37, 469–473.CrossRefGoogle ScholarPubMed
Olazaran, J. et al. (2010). Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy. Dementia and Geriatric Cognitive Disorders, 30, 161–178.CrossRefGoogle ScholarPubMed
Orrell, M., Hancock, G., Hoe, J., Woods, B., Livingston, G. and Challis, D. (2007). A cluster randomised controlled trial to reduce the unmet needs of people with dementia living in residential care. International Journal of Geriatric Psychiatry, 22, 1127–1134.CrossRefGoogle ScholarPubMed
Politis, A. M., Vozzella, S., Mayer, L. S., Onyike, C. U., Baker, A. S. and Lyketsos, C. G. (2004). A randomized, controlled, clinical trial of activity therapy for apathy in patients with dementia residing in long-term care. International Journal of Geriatric Psychiatry, 19, 1087–1094.CrossRefGoogle ScholarPubMed
Rabins, P. V., Kasper, J. D. and Kleinman, L. (1999). Concepts and methods in the development of the ADRQL: an instrument for assessing health-related quality of life in persons with Alzheimer's disease. Journal of Mental Health and Aging, 5, 33–48.Google Scholar
Selwood, A., Johnston, K., Katona, C., Lyketsos, C. and Livingston, G. (2007). Systematic review of the effect of psychological interventions on family caregivers of people with dementia. Journal of Affective Disorders, 101, 75–89.CrossRefGoogle ScholarPubMed
Spector, A. et al. (2003). Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial. British Journal of Psychiatry, 183, 248–254.CrossRefGoogle ScholarPubMed
StatsDirect (2008). StatsDirect Software: Version 2.6.6. Altrincham: StatsDirect.Google Scholar
Steinberg, M., Leoutsakos, J. M., Podewils, L. J. and Lyketsos, C. G. (2009). Evaluation of a home-based exercise program in the treatment of Alzheimer's disease: the Maximizing Independence in Dementia (MIND) study. International Journal of Geriatric Psychiatry, 24, 680–685.CrossRefGoogle ScholarPubMed
Teri, L., McCurry, S. M., Logsdon, R. and Gibbons, L. E. (2005). Training community consultants to help family members improve dementia care: a randomized controlled trial. Gerontologist, 45, 802–811.CrossRefGoogle ScholarPubMed
Vickrey, B. G. et al. (2006). The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial. Annals of Internal Medicine, 145, 713–726.CrossRefGoogle ScholarPubMed
Visser, S. M., McCabe, M. P., Hudgson, C., Buchanan, G., Davison, T. E. and George, K. (2008). Managing behavioural symptoms of dementia: effectiveness of staff education and peer support. Aging and Mental Health, 12, 47–55.CrossRefGoogle ScholarPubMed
World Health Organization (1995). The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization. Social Science and Medicine, 41, 1403–1409.CrossRefGoogle Scholar