Nonpharmacologic Interventions for Agitation and Aggression in Dementia [entered retrospectively]

Project Summary Title and Description

Title
Nonpharmacologic Interventions for Agitation and Aggression in Dementia [entered retrospectively]
Description
N/A
Attribution
N/A
Authors of Report
N/A
Methodology description
Objective. To assess the efficacy, comparative effectiveness, and adverse effects of nonpharmacologic interventions for agitation and aggression in individuals with dementia. Data sources. Ovid MEDLINE®, Ovid Embase®, and the Cochrane Central Register of Controlled Trials bibliographic databases; hand searches of references of relevant studies. Review methods. Two investigators screened abstracts and full-text articles of identified references for eligibility. Eligible studies included randomized controlled trials evaluating nonpharmacologic interventions to manage agitation/aggression in individuals with dementia in nursing homes, assisted living, or community settings. We analyzed outcomes of agitation/aggression, general behavior, patient quality of life, admission to long-term care, and staff and caregiver outcomes related to patient behavior and care burden. We assessed risk of bias, extracted data, and evaluated strength of evidence for each comparison and outcome. We analyzed pooled estimates to assess efficacy and comparative effectiveness. We conducted a qualitative analysis when data could not be pooled. Results. We identified 126 unique randomized controlled trials as of July 2015. Patient-level interventions involving music, aromatherapy with lavender, and bright light were similar to usual treatment or attention control at managing agitation/aggression in persons with dementia (low strength evidence); interventions tailored to recipients’ skills, interests, or both were similar to usual care in managing agitation/aggression in persons with dementia (low strength evidence). Care delivery-level interventions (dementia care mapping and person-centered care) were similar to usual care in managing agitation/aggression in persons with dementia (low strength evidence). Evidence was insufficient to draw conclusions on the effectiveness of most caregiver-level interventions in managing agitation/aggression in persons with dementia; Caregiver interventions targeting caregiver skills and behavior were similar to attention control in managing agitation/aggression (low strength evidence). However, these interventions show benefits in caregiver confidence in caregiving and caregiver distress. Adverse effects were rarely reported. Conclusions. Although many trials have been conducted to determine effective nonpharmacologic intervention for agitation/aggression in dementia, the variety of comparisons, measurement issues, and other methodological limitations provided a weaker evidence base than is needed for such a critical topic. When evidence was sufficient to draw conclusions about effectiveness for a group of interventions, agitation/aggression outcomes were typically similar to controls. Future research is needed to guide providers and informal caregivers towards effective interventions for agitation/aggression in dementia.
PROSPERO
N/A
DOI
10.7301/Z03N21B6
Notes
Web address not yet available. Data entered retrospectively. Word tables contain basic study information, population information, and risk of bias assessments. Data were not extracted from studies receiving a "high" risk of bias assessment.
Funding Source
AHRQ

Key Questions

1. What is the comparative effectiveness of nonpharmacologic interventions in preventing and responding to agitation/aggression among individuals with dementia who reside in nursing home and assisted living settings?
2. What are the comparative harms of nonpharmacologic interventions in preventing and responding to agitation/aggression among individuals with dementia who reside in nursing home and assisted living settings?
3. What is the comparative effectiveness of nonpharmacologic interventions in preventing and responding to agitation/aggression among community-dwelling individuals with dementia?
4. What are the comparative harms of nonpharmacologic interventions in preventing and responding to agitation/aggression among community-dwelling individuals with dementia?

Associated Extraction Forms

Associated Studies (each link opens a new tab)

TitleAuthorsYear
Effect of light on agitation in institutionalized patients with severe Alzheimer disease.
A comparison of the effects of Snoezelen and reminiscence therapy on the agitated behaviour of patients with dementia.
Effects of multi-sensory stimulation for people with dementia.
Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: a randomized, controlled trial.
Effective caregiving approaches for patients with Alzheimer's disease.
Bright light therapy for agitation in dementia: a randomized controlled trial.2009
Effectiveness of advanced illness care teams for nursing home residents with dementia.
Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial.
AwareCare: a pilot randomized controlled trial of an awareness-based staff training intervention to improve quality of life for residents with severe dementia in long-term care settings.2013
Use of music to decrease aggressive behaviors in people with dementia.1998
Nonpharmacological treatment of agitation: a controlled trial of systematic individualized intervention.
Efficacy of nonpharmacologic interventions for agitation in advanced dementia: a randomized, placebo-controlled trial.
A randomized controlled trial exploring the effect of music on agitated behaviours and anxiety in older people with dementia.
Effectiveness of validation therapy (VT) in group: preliminary results.-- Not Found --
Non-pharmacological management of behavioural symptoms in nursing homes.
Light treatment for neuropsychiatric behaviors in Alzheimer's disease.
Therapeutic recreation interventions for need-driven dementia-compromised behaviors in community-dwelling elders.-- Not Found --
A randomised controlled trial of the use of aromatherapy and hand massage to reduce disruptive behaviour in people with dementia.
Lavender aroma therapy for behavioral and psychological symptoms in dementia patients.2008
Optimizing function and physical activity among nursing home residents with dementia: testing the impact of function-focused care.
Function Focused Care for Assisted Living Residents With Dementia.2015
A comparison of two treatments of agitated behavior in nursing home residents with dementia: simulated family presence and preferred music.2007
Effects of individualized versus classical "relaxation" music on the frequency of agitation in elderly persons with Alzheimer's disease and related disorders.2000
Tailored activities to manage neuropsychiatric behaviors in persons with dementia and reduce caregiver burden: a randomized pilot study.
Effects of the home environmental skill-building program on the caregiver-care recipient dyad: 6-month outcomes from the Philadelphia REACH Initiative.
A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: the COPE randomized trial.
Targeting and managing behavioral symptoms in individuals with dementia: a randomized trial of a nonpharmacological intervention.
Project CARE: a randomized controlled trial of a behavioral intervention group for Alzheimer's disease caregivers.
Enhancing resourcefulness to improve outcomes in family caregivers and persons with Alzheimer's disease: a pilot randomized trial.
Effect of the bathing without a battle training intervention on bathing-associated physical and verbal outcomes in nursing home residents with dementia: a randomized crossover diffusion study.
Helping carers to care: the 10/66 dementia research group's randomized control trial of a caregiver intervention in Peru.
Personal home made digital video disk for patients with behavioral psychological symptoms of dementia.2010
Therapeutic touch and agitation in individuals with Alzheimer's disease.2008
Impact of TimeSlips creative expression program on behavioral symptoms and psychotropic medication use in persons with dementia in long-term care: a cluster-randomized pilot study.
Favorable effect of transcranial electrostimulation on behavior disorders in elderly patients with dementia: a double-blind study.
A randomized controlled trial of the group reminiscence approach in patients with vascular dementia.2007
Care intervention for older adults with Alzheimer's disease and related dementias: effect of family involvement on cognitive and functional outcomes in nursing homes.
A randomized clinical trial of theory-based activities for the behavioral symptoms of dementia in nursing home residents.
Efficacy of theory-based activities for behavioral symptoms of dementia.-- Not Found --
Effects of the Serial Trial Intervention on discomfort and behavior of nursing home residents with dementia.
Effect of the BACE intervention on agitation of people with dementia.
Physical activity and behavior in the elderly: a pilot study.
A stimulation-retreat special care unit for elders with dementing illness.1998
Using acupressure and Montessori-based activities to decrease agitation for residents with dementia: a cross-over trial.
Efficacy of aromatherapy (Lavandula angustifolia) as an intervention for agitated behaviours in Chinese older persons with dementia: a cross-over randomized trial.
Effectiveness of group music intervention against agitated behavior in elderly persons with dementia.
Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease.
An RCT to evaluate the utility of a clinical protocol for staff in the management of behavioral and psychological symptoms of dementia in residential aged-care settings.
An evaluation of a family visit education program.
Educating nursing assistants to communicate more effectively with nursing home residents with dementia.
Multisensory stimulation for elderly with dementia: a 24-week single-blind randomized controlled pilot study.
Effects of a caregiver intervention on negative caregiver appraisals of behavior problems in patients with Alzheimer's disease: results of a randomized trial.
Can training community mental health nurses to support family carers reduce behavioural problems in dementia? An exploratory pragmatic randomised controlled trial.
Foot massage versus quiet presence on agitation and mood in people with dementia: a randomised controlled trial.
Efficacy of musical interventions in dementia: evidence from a randomized controlled trial.
The effect of a structured intervention on caregivers of patients with dementia and problem behaviors: a randomized controlled pilot study.
Reducing caregiver burden: a randomized psychoeducational intervention for caregivers of persons with dementia.
Behavioural management in nursing and residential homes: a randomised controlled trial.
Efficacy of music therapy treatment based on cycles of sessions: a randomised controlled trial.
Agitation in nursing home residents with dementia (VIDEANT trial): effects of a cluster-randomized, controlled, guideline implementation trial.
Individual music therapy for agitation in dementia: an exploratory randomized controlled trial.
Efficacy of a sensory integration program on behaviors of inpatients with dementia.1994
Ear therapy and massage therapy in the elderly with dementia: a pilot study.2013
The effect of person-centred dementia care to prevent agitation and other neuropsychiatric symptoms and enhance quality of life in nursing home patients: a 10-month randomized controlled trial.
Exercise program for nursing home residents with Alzheimer's disease: a 1-year randomized, controlled trial.
Comparing the effects of different individualized music interventions for elderly individuals with severe dementia.2013
Effects of emotion-oriented care on elderly people with cognitive impairment and behavioral problems.
Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation, and discomfort in nursing home residents with dementia: a randomized, controlled trial.
Aromatherapy and behaviour disturbances in dementia: a randomized controlled trial.
The effects of Snoezelen (multi-sensory behavior therapy) and psychiatric care on agitation, apathy, and activities of daily living in dementia patients on a short term geriatric psychiatric inpatient unit.
The effects of group music with movement intervention on agitated behaviours of institutionalized elders with dementia in Taiwan.
A group music intervention using percussion instruments with familiar music to reduce anxiety and agitation of institutionalized older adults with dementia.
Music therapy in moderate and severe dementia of Alzheimer's type: a case-control study.2006
Effect of a high-intensity exercise program on physical function and mental health in nursing home residents with dementia: an assessor blinded randomized controlled trial.
Treatment of agitation in AD: a randomized, placebo-controlled clinical trial.2000
The effect of staff training on the use of restraint in dementia: a single-blind randomised controlled trial.2005
A randomized controlled trial of a home hospital intervention for frail elderly demented patients: behavioral disturbances and caregiver's stress.2004
A one-year randomized controlled psychosocial intervention study among family carers of dementia patients--effects on patients and carers.
Effects of dementia-care mapping on residents and staff of care homes: a pragmatic cluster-randomised controlled trial.
Cognitive and behavioural effects of music-based exercises in patients with dementia.
A randomized crossover trial to study the effect of personalized, one-to-one interaction using Montessori-based activities on agitation, affect, and engagement in nursing home residents with Dementia.2013
A randomized controlled trial for an individualized positive psychosocial intervention for the affective and behavioral symptoms of dementia in nursing home residents.
The effect of music therapy compared with general recreational activities in reducing agitation in people with dementia: a randomised controlled trial.
No long-term effect of behavioral treatment on psychotropic drug use for agitation in Alzheimer's disease patients.2002
Providing activity for people with dementia in care homes: a cluster randomised controlled trial.
The effect of therapeutic touch on behavioral symptoms and cortisol in persons with dementia.2009
The effect of therapeutic touch on behavioral symptoms of persons with dementia.
Continuum of care for Alzheimer's disease: a nurse education and counseling program.
Comparison of the efficacy of aroma-acupressure and aromatherapy for the treatment of dementia-associated agitation.
Coming to grips with challenging behavior: a cluster randomized controlled trial on the effects of a multidisciplinary care program for challenging behavior in dementia.
Sonas: a pilot study investigating the effectiveness of an intervention for people with moderate to severe dementia.2014
Cluster Randomized Controlled Trial of An Aged Care Specific Leadership and Management Program to Improve Work Environment, Staff Turnover, and Care Quality.2015
A randomized controlled trial of the effects of multi-sensory stimulation (MSS) for people with dementia.2001
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.
Effects of behavioral interventions on disruptive behavior and affect in demented nursing home residents.
Skills Training for Spouses of Patients with Alzheimer's Disease: Outcomes of an Intervention Study2002
Impact of two psychosocial interventions on white and African American family caregivers of individuals with dementia.
A double-blind placebo-controlled randomized trial of Melissa officinalis oil and donepezil for the treatment of agitation in Alzheimer's disease.
Evaluation of Simulated Presence: a personalized approach to enhance well-being in persons with Alzheimer's disease.
A disease management program for families of persons in Hong Kong with dementia.2008
Controlled trial of dementia training with a peer support group for aged care staff.
Do patients diagnosed with Alzheimer's disease benefit from a psycho-educational programme for family caregivers? A randomised controlled study.
The effect of integrated emotion-oriented care versus usual care on elderly persons with dementia in the nursing home and on nursing assistants: a randomized clinical trial.
Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial.
Effectiveness of a psychoeducational skill training DVD program to reduce stress in Chinese American dementia caregivers: Results of a preliminary study
Impact of a psychoeducational intervention on caregiver response to behavioral problems.2002
Behavioural management of aggression in dementia: a randomized controlled trial.
Effectiveness of a psychoeducational skill training DVD program to reduce stress in Chinese American dementia caregivers: results of a preliminary study.2010
Controlled study on the cognitive and psychological effect of coloring and drawing in mild Alzheimer's disease patients.
Efficacy of a support group programme for care-givers of demented patients in the community: a randomized controlled trial.1994
Favorite music and hand massage2008
A home-based training program improves caregivers skills and dementia patients aggressive behaviors: a randomized controlled trial.
Effects of Widespread and Frequent Personalized Music Programming on Agitation and Depression in Assisted Living Facility Residents With Alzheimer-Type Dementia2012
Staff outcomes from the caring for aged dementia care resident study (CADRES): a cluster randomised trial.2012
A psycho-educational intervention focused on communication for caregivers of a family member in the early stage of Alzheimer’s disease: Results of an experimental study
Capturing interests: therapeutic recreation activities for persons with dementia. 2001
Pilot study of behavioral treatment in dementia care units.2005
The Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE) study: cluster randomised trial of humour therapy in nursing homes.
A randomized, controlled trial of bright light therapy for agitated behaviors in dementia patients residing in long-term care.1999
Impact of training dementia caregivers in sensitivity to nonverbal emotion signals.2002
Touch on the acupoint of Shinchuu of Alzheimer's disease patients.2015
Effects of Multisensory Stimulation on a Sample of Institutionalized Elderly People With Dementia Diagnosis: A Controlled Longitudinal Trial.2014
Can we help persons with dementia find their way in a new environment?2003
Addendum to 'Efficacy of music therapy treatment based on cycles of sessions: a randomised controlled trial' (Raglio et al., 2010).2012
Calming music and hand massage with agitated elderly.-- Not Found --
Evaluation of a home-based exercise program in the treatment of Alzheimer's disease: the Maximizing Independence in Dementia (MIND) study.
STAR: a dementia-specific training program for staff in assisted living residences.2005
The effect of staff training on agitation and use of restraint in nursing home residents with dementia: a single-blind, randomized controlled trial.2010
Managing behavioural symptoms of dementia: effectiveness of staff education and peer support.
Effects of an abilities-focused program of morning care on residents who have dementia and on caregivers.

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