Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials

• Published in: British journal of psychiatry Vol. 205; no. 6; pp. 436 - 442
• Main Authors: Livingston, Gill, Kelly, Lynsey, Lewis-Holmes, Elanor, Baio, Gianluca, Morris, Stephen, Patel, Nishma, Omar, Rumana Z., Katona, Cornelius, Cooper, Claudia
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.12.2014; Maney
• Subjects: Aging; Agitation; Alzheimer's disease; Aromatherapy; Behavior; Behavioral Symptoms - etiology; Behavioral Symptoms - psychology; Behavioral Symptoms - therapy; Biological and medical sciences; Caregivers; Clinical Competence; Clinical significance; Clinical trials; Communication skills training; Dementia; Dementia - complications; Dementia - psychology; Dementia disorders; Drugs; Efficacy; Evidence-Based Practice; Humans; Institution therapy. Inpatient treatment; Intervention; Light therapy; Mapping; Medical sciences; Music therapy; Music Therapy - methods; Nursing homes; Patient-centered care; Patient-Centered Care - methods; Patient-Centered Care - organization & administration; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychomotor Agitation - etiology; Psychomotor Agitation - psychology; Psychomotor Agitation - therapy; Psychopathology. Psychiatry; Psychotropic drugs; Quality of life; Randomized Controlled Trials as Topic; Residential care; Review articles; Skill development; Socioeconomic status; Socioenvironmental Therapy - methods; Systematic review; Treatments; United Kingdom; Europe; United Kingdom > UK; Social environment; Human; Musicotherapy; Nervous system diseases; Agitation; Group treatment; Indication; Health staff; Mental health; Specialized institution; Activity; Controlled therapeutic trial; Review; Cerebral disorder; Treatment; Central nervous system disease; Degenerative disease; Application method; Massage; Person-centered approach; Occupational training; Public health; Communication; Dementia
• ISSN: 0007-1250; 1472-1465
• DOI: 10.1192/bjp.bp.113.141119

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