Date Presented 4/19/2018
Nine studies were included in this review. The following key terms were used: community-based intervention, dementia, randomized controlled trial, and systematic review. The review provides a basis supporting the effectiveness of community-based interventions for people with dementia.
Primary Author and Speaker: Ga-In Shin
Additional Authors and Speakers: Ye-Shin Woo, Seul Gi Koo, Mi Ji Kim, Hae Yean Park
PURPOSE: The purpose of this study was to provide a basis supporting the effectiveness of community-based interventions for people with dementia and to inform future community-based intervention methods and high-quality services.
RATIONALE AND BACKGROUND: In Korea, people with dementia tend to live in the home rather than a hospital or other care center and to be cared for by family members. To ease the burden of dementia on the elderly population, caregivers, and society, a therapeutic approach to social participation and independent living is important. Community-based interventions are strategies implemented within the community for the purpose of rehabilitation, equal opportunity, and social integration for all people with disabilities.
METHOD: We conducted a systematic review of journal articles published in English and Korean using the Research Information Sharing Service, PubMed, and Google Scholar. The search focused on Level I studies published from 2007 to 2017. The following key words were used: Dementia OR Alzheimer OR Dwelling–adult AND Home-based OR Home-based intervention OR Community-based OR Community-based intervention AND RCT OR Randomized. A total of 375 articles were found through several database searches. After careful review, only nine articles were included in this analysis.
The nine studies were analyzed using the hierarchy of levels of evidence for evidence-based practice. The details of each study were classified and analyzed on the basis of type of intervention, evaluation tool, evaluation area, and professionals who performed the intervention. Selected articles were systematically organized using the PICO framework.
RESULTS: All nine articles were Level 1 of the five-level classification; all were randomized controlled trials. Five of the articles focused on dementia only. The most frequent intervention was an exercise program (three articles), and single-domain interventions were used more often than complex interventions. Community-based interventions were effective in producing improvements in the physical domain of people with dementia and the quality of life domain of caregivers. Effective interventions addressed the areas of exercise, cognition, quality of life, and activities of daily living. The most frequent interveners were physical therapists (33.2%), occupational therapists (26.7%), and nurses (26.7%).
CONCLUSION: As the number of people with dementia continues to increase, more will live in the community because of the social cost burden, and community-based intervention will be increasingly emphasized in the future. Therefore, occupational therapy practitioners should be aware of the importance of community participation for the quality of life of people with dementia and their caregivers, and appropriate methods, frequency, and duration of interventions should be studied in Korea. This study suggests that community-based interventions may have a positive effect on people with dementia and their caregivers. On the basis of these results, practitioners should use various community-based interventions to increase client participation in the community.
IMPACT STATEMENT: Increasing numbers of people with dementia will require community-based intervention. Occupational therapy practitioners should be aware of the importance of community involvement and quality of life for people with dementia and their caregivers and should study the appropriate methods, frequency, and duration of community interventions.
References
Farran, C. J., Gilley, D. W., McCann, J. J., Bienias, J. L., Lindeman, D. A., & Evans, D. A. (2007). Efficacy of behavioral interventions for dementia caregivers. Western Journal of Nursing Research, 29, 944–960. https://doi.org/10.1177/0193945907303084
Gitlin, L. N., Winter, L., Dennis, M. P., Hodgson, N., & Hauck, W. W. (2010). A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: The COPE randomized trial. JAMA, 304, 983–991. https://doi.org/10.1001/jama.2010.1253
Huang, H.-L., Kuo, L.-M., Chen, Y.-S., Liang, J., Huang, H.-L., Chiu, Y.-C., . . . Shyu, Y.-I. L. (2013). A home-based training program improves caregivers’ skills and dementia patients’ aggressive behaviors: A randomized controlled trial. American Journal of Geriatric Psychiatry, 21, 1060–1070. https://doi.org/10.1016/j.jagp.2012.09.009
