Date Presented 4/19/2018
We systematically reviewed nine studies located using the key terms dementia, activities of daily living (ADLs), and nonpharmacological interventions. The study provides evidence for understanding nonpharmacological interventions to improve ADL performance in people with dementia.
Primary Author and Speaker: Seul Gi Koo
Additional Authors and Speakers: Mi Ji Kim, Ye Shin Woo, Ga In Shin, Hae Yean Park, Ji Hyuk Park
BACKGROUND AND PURPOSE: The purpose of this study was to provide general information on nonpharmacological interventions and their effectiveness to dementia experts in clinical practice. In Korea, the proportion of patients with dementia is increasing because of rapid aging of the population. Patients with dementia experience loss of memory, cognitive function, and ability to perform activities of daily living (ADLs), affecting the quality of life of both patients and caregivers. Therefore, ADLs are an important factor to address in patients with dementia, and pharmacological and nonpharmacological interventions have been applied in their treatment. Nonpharmacological interventions have recently been emphasized because they have no side effects and are of great therapeutic value. Therefore, this study explored nonpharmacological interventions used with dementia patients and the effectiveness of these interventions.
METHOD: In this systematic review, we searched for articles published in English using MEDLINE, PubMed Central, and Scopus. The search was limited to Level I, II, and III studies published between January 2007 and November 2016. The main key words used were “Dementia AND (ADL OR Activities of daily living) AND Nonpharmacological interventions.” The search located 974 articles; nine were included in the analysis. The nine articles were analyzed using the hierarchy of levels of evidence for evidence-based practice. The details of each study were classified and examined according to intervention type, research field, use of ADL assessment tools, and dependent variables including ADLs.
RESULTS: Three studies each provided Level I, II, and III evidence. In addition, seven of the nine studies were published between 2012 and 2016, indicating the more recent emphasis on nonpharmacological interventions. Intervention methods addressed cognition, exercise, and activities and were individually tailored and interdisciplinary. The most frequently provided nonpharmacological intervention was exercise, and the highest proportion of studies were in rehabilitation fields. The most frequently used assessment tool was the Barthel Index, and cognition was most frequent dependent variable measured along with ADLs.
CONCLUSION: A growing body of research has addressed nonpharmacological interventions to support ADLs in patients with dementia. Although various intervention methods have been examined, including exercise, cognition, and activity, little evidence of their effectiveness is available. Also, we found no studies that evaluated specific ADL interventions providing training in food preparation, housekeeping, grooming, toileting, and so forth. This study provides evidence of the current understanding of nonpharmacological interventions for ADL performance in patients with dementia. Future research is need to identify ADL training interventions appropriate to the patient’s level of dementia.
IMPACT STATEMENT: Dementia affects the occupation of ADLs for patients and caregivers, and interventions should be provided to improve occupational performance. Occupational therapy practitioners play an important role in treatment of patients with dementia, and this study provides useful information on nonpharmacological interventions for this patient population.
References
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