Non-pharmacological interventions for agitation in dementia

systematic review of randomised controlled trials

Livingston, Gill
Kelly, Lynsey
Lewis-Holmes, Elanor
Baio, Gianluca
Morris, Stephen
Patel, Nishma
Omar, Rumana Z.
Katona, Cornelius
Cooper, Claudia

Gill Livingston, MD, Lynsey Kelly, BSc, Elanor Lewis-Holmes, BSc, Unit of Mental Health Sciences, Gianluca Baio, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Stephen Morris, PhD, Nishma Patel, MSc, Department of Applied Health Research, Rumana Z. Omar, PhD, Departments of Statistical Science and PRIMENT Clinical Trials Unit, Cornelius Katona, MD, Claudia Cooper, PhD, Unit of Mental Health Sciences, University College London, UK

Correspondence: Professor Gill Livingston, Charles Bell House, 67–73 Riding House Street, London W1W 7EH, UK. Email: [email protected]

Declaration of interest: None.

First received 30 Oct 2013, final revision 29 Apr 2014, accepted 12 Jul 2014

British Journal of Psychiatry 205(6):p 436-442, December 2014.

Background

Agitation in dementia is common, persistent and distressing and can lead to care breakdown. Medication is often ineffective and harmful.

Aims

To systematically review randomised controlled trial evidence regarding non-pharmacological interventions.

Method

We reviewed 33 studies fitting predetermined criteria, assessed their validity and calculated standardised effect sizes (SES).

Results

Person-centred care, communication skills training and adapted dementia care mapping decreased symptomatic and severe agitation in care homes immediately (SES range 0.3–1.8) and for up to 6 months afterwards (SES range 0.2–2.2). Activities and music therapy by protocol (SES range 0.5–0.6) decreased overall agitation and sensory intervention decreased clinically significant agitation immediately. Aromatherapy and light therapy did not demonstrate efficacy.

Conclusions

There are evidence-based strategies for care homes. Future interventions should focus on consistent and long-term implementation through staff training. Further research is needed for people living in their own homes.