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

Br J Psychiatry. 2014 Dec;205(6):436-42. doi: 10.1192/bjp.bp.113.141119.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Behavioral Symptoms / etiology
  • Behavioral Symptoms / psychology
  • Behavioral Symptoms / therapy
  • Clinical Competence
  • Dementia* / complications
  • Dementia* / psychology
  • Evidence-Based Practice
  • Humans
  • Music Therapy / methods*
  • Patient-Centered Care / methods
  • Patient-Centered Care / organization & administration
  • Psychomotor Agitation* / etiology
  • Psychomotor Agitation* / psychology
  • Psychomotor Agitation* / therapy
  • Randomized Controlled Trials as Topic
  • Socioenvironmental Therapy / methods*