Non-pharmacological care-delivery interventions may reduce agitation and aggression in nursing home residents with dementia

Jutkowitz E, Brasure M, Fuchs E, et al.  Les interventions de prestation de soins visant à gérer l'agitation et l'agressivité dans la démence chez les résidents des centres d'hébergement et de soins de longue durée ainsi que des logements avec assistance: Une revue systématique et méta-analyse  Journal of the American Geriatrics Society. 2016 Mark;64(3):477-488

Review question

What is the efficacy of non-pharmacological care-delivery interventions, such as staff training, in reducing and managing agitation and aggression in nursing homes and assisted-living residents, specifically for residents with dementia?

Background

As many as 90% of patients with dementia experience behaviour and psychological symptoms, including aggression and agitation.

Traditional care in nursing homes can make it difficult to manage patients with dementia since the agitation and aggression may reduce psychological health of the staff, reduce job satisfaction and lead to staff turnover.

Non-pharmacological care-delivery interventions may be a promising solution to this challenge, as they may reduce and manage agitation and aggression in assisted-living facility residents with dementia.

How the review was done

A detailed search of a number of electronic databases for all years up to and including July 2015 was conducted, and studies that focused on non-pharmacological interventions designed to reduce agitation or aggression in community-dwelling or institutionalized individuals with dementia were included.

A total of 410 studies were identified in searches, and 19 were included in the review after assessments for eligibility.

This review was funded by the University of Minnesota.

What the researchers found

The review found that dementia-care mapping (i.e., identifying and responding to presumed causes of agitation and aggression) resulted in a lower frequency of agitation and aggression, but the reduction in frequency was very small.

Person-centred care, which aims to improve positive relationships with others as dementia progresses, was associated with reduced agitation and aggression, but not at a clinically meaningful level.

Emotion-oriented care, where staff are trained to better understand the resident’s perspective of the environment and the importance of communication skills in the caregiver-patient relationship, was not found to be associated with positive or negative effects on agitation or aggression.

Conclusion

This review found that certain non-pharmacological care-delivery interventions, such as person-centred care and dementia-care mapping, have the potential to reduce agitation and aggression in dementia patients in nursing homes. However, further research is required to consolidate these findings and to more clearly understand which interventions can be effective.