Reminiscence therapy for dementia

Woods, B.,  O’Philbin, L.Farrell, E.M.Spector, A.EOrrell, M.  | Reminiscence therapy for dementiaCochrane Database of Systematic Reviews  |  2018  | Issue 3. | DOI: 10.1002/14651858.CD001120.pub3

Cochrane Library had produced an update to a systematic review, on reminiscence therapy (RT) previously updated in 2005. RT involves the discussion of memories and past experiences with other people using tangible prompts such as photographs or music to evoke memories and stimulate conversation. It is implemented widely in a range of settings using a variety of formats (Cochrane Database of Systematic Reviews). The plain language summary is given below.

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Reminiscence therapy for dementia

Review question

We wanted to find out what effect reminiscence therapy (RT) has on people with dementia. In particular, we were interested in effects on quality of life, communication, cognition (the general ability to think and remember), mood, daily activities and relationships. We were also interested in any effects on carers.

Background

RT involves discussing events and experiences from the past. It aims to evoke memories, stimulate mental activity and improve well-being. Reminiscence is often assisted by props such as videos, pictures and objects. It can take place in a group or be done with a person on their own, when it often results in some form of life-story book being created. RT helps older people with depression. It may be suitable for people with dementia both because depression is common in dementia and because people with dementia typically have a better memory for the distant past than for recent events.

Methods

We searched for randomised, controlled trials in which RT was compared with no treatment or with a non-specific activity, such as time spent in general conversation. Our search covered all trials available up to April 2017.

Results

We found 22 trials with 1972 participants to include in the review. All the participants had dementia, mostly of mild or moderate severity. Some of the participants were living at home and some were in care homes. The length of the trials varied from four weeks to two years, and the overall amount of time spent on therapy varied from three to 39 hours. Overall, we thought most of the trials were well conducted.

Looking at all the trials together, there did not seem to be an effect of RT on the quality of life reported by the participants. However, there was probably a slight benefit of treatment in the trials done in care homes, which was not seen in the trials done in the community.

People having RT scored slightly better than the control group on tests of cognition immediately after the course of treatment, but not weeks to months later. It was not clear that the effect was large enough to be important. The effect was most evident in care home studies, which used individual RT, but not in community studies, which used group RT.

We found that group RT and RT in community settings may have a positive effect on the communication and interaction of the person with dementia immediately after the end of treatment, and probably also weeks to months later, although the effect was small.

Apart from a probable slight benefit of individual RT on scales measuring depressed mood, we found no evidence for effects of RT on other outcomes, such as agitation, ability to carry out daily activities or relationships with other people. We found no evidence of harmful effects of RT for the people with dementia themselves.

We found no effect of RT on family carers other than a suggestion that it made carers slightly more anxious in two large studies of joint reminiscence work. In this type of RT, the carers and the people with dementia were both directly involved in the reminiscence sessions.

Conclusions

We were encouraged to find that the amount and quality of research on RT for dementia has increased considerably since the last version of this review. We concluded that the effects of RT vary, depending on the way it is given and whether it takes place in care homes or the community. However, there is some evidence that RT can improve quality of life, cognition, communication and possibly mood in people with dementia in some circumstances, although all the benefits were small. More research is needed to understand these differences and to find out who is likely to benefit most from what type of RT.

The abstract and the full text systematic review is available from The Cochrane Library, alternatively it can be downloaded here

Psychosocial interventions for people with dementia

New research finds good evidence to suggest that multi-component exercise with sufficient intensity improves global physical and cognitive functions and activities of daily living skills for people with dementia | Aging & Mental Health

Objectives: Over the last 10 years there has been a multitude of studies of psychosocial interventions for people with dementia. However, clinical services face a dilemma about which intervention should be introduced into clinical practice because of the inconsistency in some of the findings between different studies and the differences in the study qualities and trustworthiness of evidence. There was a need to provide a comprehensive summary of the best evidence to illustrate what works.

Methods: A review of the systematic reviews of psychosocial interventions in dementia published between January 2010 and February 2016 was conducted.

Results: Twenty-two reviews (8 physical, 7 cognitive, 1 physical/cognitive and 6 other psychosocial interventions) with a total of 197 unique studies met the inclusion criteria. Both medium to longer-term multi-component exercise of moderate to high intensity, and, group cognitive stimulation consistently show benefits. There is not sufficient evidence to determine whether psychological or social interventions might improve either mood or behaviour due to the heterogeneity of the studies and interventions included in the reviews.

Conclusion: There is good evidence that multi-component exercise with sufficient intensity improves global physical and cognitive functions and activities of daily living skills. There is also good evidence that group-based cognitive stimulation improves cognitive functions, social interaction and quality of life. This synthesis also highlights the potential importance of group activities to improve social integration for people with dementia. Future research should investigate longer-term specific outcomes, consider the severity and types of dementia, and investigate mechanisms of change.

Full reference: McDermott, O et al. | Psychosocial interventions for people with dementia: a synthesis of systematic reviews |Aging & Mental Health | Published online 17 Jan 2018

View the full article here

 

A critical literature review of the effectiveness of various instruments in the diagnosis of dementia in adults with intellectual disabilities

Elliott-King, J. et al. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring. Published online: 29 June 2016

http://creativecommons.org/licenses/by/3.0
Image source: Charles Hamm – Wikipedia // CC BY 3.0

Currently, there is no consensus on dementia diagnostics in adults with intellectual disabilities (IDs). There are three types of assessments available: direct cognitive tests, test batteries, and informant reports.

A systematic literature search was conducted in four databases yielding 9840 records. Relevant studies were identified and selected using predefined inclusion and exclusion criteria and then coded and classified according to assessment type. This was completed by two independent researchers, with a third consulted when discrepancies arose. The review collates diagnostic instruments and presents strengths and weaknesses.

Overall 47 studies met the search criteria, and 43 instruments were extracted from the selected studies. Of which, 10 instruments were classified as test batteries, 23 were classified as direct cognitive tests, and the remaining 10 were informant reports.

This review can recommend that test batteries can offer the most practical and efficient method for dementia diagnosis in individuals with ID.

Read the full article here

Psychosocial interventions for people with dementia: An overview and commentary on recent developments

Oyebode, J.R. & Parveen, S. Dementia. Published online: 4 July 2016

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Image source: Bill McConkey – Wellcome Images // CC BY-NC-ND 4.0

An influential review in 2010 concluded that non-pharmacological multi-component interventions have positive effects on cognitive functioning, activities of daily living, behaviour and mood of people with dementia. Our aim here is to provide an up-to-date overview of research into psychosocial interventions and their impact on psychosocial outcomes.

We focused on randomised controlled trials, controlled studies and reviews published between October 2008 and August 2015, since the earlier review. The search of PsychInfo, Medline and the Cochrane database of systematic reviews yielded 61 relevant articles, organised into four themes echoing key phases of the care pathway: Living at home with dementia (five reviews, eight studies), carer interventions (three reviews, four studies), interventions in residential care (16 reviews, 12 studies) and end-of-life care (three reviews, two studies), along with an additional group spanning community and institutional settings (six reviews, two studies).

Community findings suggested that appointment of dementia specialists and attention to case management can produce positive outcomes; physical therapies, cognitive training and modified cognitive behaviour therapy also had a range of benefits. There was more limited evidence of positive benefits for people with dementia through interventions with family carers. Thirty-two articles focused on the management of ‘behavioural symptoms’ through a range of interventions all of which had some evidence of benefit. Also a range of multi-component and specific interventions had benefits for cognitive, emotional and behavioural well-being of people with dementia in residential settings, as well as for quality of life. Overall, interventions tended to be short term with impact only measured in the short term.

We recommend further research on interventions to promote living well in the community post-diagnosis and to address end-of-life care. Development of psychosocial interventions would benefit from moving beyond the focus on control of behaviours to focus on wider aspects of life for people with dementia.

Read the abstract here

Living positively with dementia

Aging & Mental Health Volume 20, Issue 7, 2016

Objective: Little is known about how and to what extent people with dementia live positively with their condition. This study aimed to review and carry out a synthesis of qualitative studies where accounts of the subjective experiences of people with dementia contained evidence of positive states, experiences or attributes.

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image source: Adrian Cousins,  Wellcome images//CC BY-NC-ND 4.0

Methods: A meta-synthesis was undertaken to generate an integrated and interpretive account of the ability of people with dementia to have positive experiences. A methodological quality assessment was undertaken to maximize the reliability and validity of this synthesis and to contextualize the findings with regard to methodological constraints and epistemological concepts.

Findings: Twenty-seven papers were included. Three super-ordinate themes relating to positive experiences and attributes were identified, each with varying and complementing sub-themes. The first super-ordinate theme related to the experience of engaging with life in ageing rather than explicitly to living with dementia. The second theme related to engaging with dementia itself and comprised the strengths that people can utilize in facing and fighting the condition. The third theme captured how people with dementia might transcend the condition and seek ways to maintain identity and even achieve personal growth.

Conclusions: This review provides a first step towards understanding what conceptual domains might be important in defining positive outcomes for people who live with dementia. Highlighting the potential for people to have positive experiences in spite of or even because of their dementia has important implications for de-stigmatizing dementia and will enhance person-centred approaches to care.

Full reference:  Wolverson, E.L. et al. Living positively with dementia: a systematic review and synthesis of the qualitative literature  Aging & Mental Health. Volume 20, Issue 7, 2016 p. 676-699

 

Day care centres for people with dementia

The influence of day care centres for people with dementia on family caregivers: an integrative review of the literature.
Aging & Mental Health Volume 20, Issue 5, 2016

Objectives: Day care centres (DCC) for people with dementia (PWD) have received increased attention recently, due to a shift in policy from the use of residential care towards home-based services. The aim of this study is to provide an extended understanding of the influence of DCCs on family caregivers (FCs).

Method: An integrative review including 19 studies was used: qualitative (n = 2), quantitative non-randomised (n = 8), quantitative descriptive studies (n = 7), and with mixed-method design (n = 2). The quality of the studies was evaluated by the mixed-methods appraisal tool (MMAT).

Results: FC experienced the DCC both as a respite service, and to some extent as a support service, improving their competence in caring for the PWD. The quality of the DCC influenced its use, and the FC’s motivation to care for the PWD. FC’s gender, role, individual needs, PWD behavioural problems and need for assistance played an important role.

Conclusion: As a respite and support service, DCCs have the potential to give FCs a feeling of safety and relief, reduce the caregiver’s burden, and increase their motivation towards their role as caregivers. These outcomes depend on the quality of treatment, and how the service meets the FC’s needs for flexibility, support, information, and responsibility sharing.

How people come to recognise a problem and seek medical help for a person showing early signs of dementia

Dementia published online January 12, 2016

Evidence suggests that there is usually a long delay between noticing first signs of dementia and seeking medical help.The authors  conducted a systematic review of what people experience and how they make decisions during this time.

People with dementia mainly report experiencing memory lapses, while carers focus on more subtle changes in personality. People respond to these changes in one of three ways: 1) they discount them as normal; 2) they reserve judgement as to their cause and significance, or 3) they misattribute them.

Pivotal events can finally trigger help seeking. Active reflection and seeking of further evidence may lead to earlier recognition of the possibility of dementia and the need to seek help; it also reduces the risk of a pivotal event.

Public education should aim to improve recognition of more subtle signs and to encourage repeated evaluation and reflection.

Read the full paper: Perry-Young, L et al.  How people come to recognise a problem and seek medical help for a person showing early signs of dementia: A systematic review and meta-ethnography. Dementia. Published online before print January 12, 2016