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SR Template FINAL 010210 A systematic review of the literature July 2010 The effectiveness of non-pharmacological interventions for behavioural and psychological symptom management for people with dementia in residential care settings Arindam Basu David Brinson 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) i 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 ii 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: [email protected] 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 iii 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 review. 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. Methods 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 iv (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
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