Strategies for implementing music-based interventions for people with dementia: A systematic review

Abstract Previous research has found that music-based interventions are effective at improving several outcomes related to dementia for nursing home residents. Some studies have investigated the implementation of music-based interventions. However, to date, there is no synthesis available regarding strategies and outcomes of these implementation studies. This study aims to synthesize available evidence regarding implementation strategies and outcomes of music-based interventions for nursing home residents with dementia. We conducted a systematic literature search in PsychInfo, PubMed, MEDLINE, CINAHL, and The Cochrane Library. A total of 8 studies were included for the qualitative synthesis. Of the eight studies, half were studies of music therapy and the other half were on individualized music. We identified 49 implementation strategies. The most frequently reported category of strategies was planning (34.7%), followed by education (24.5%), quality management (24.5%), restructuring (12.2%), and finance (4.1%). No strategies under the category of attending to the policy context were reported. We identified 21 implementation outcomes. The most frequently reported category was adoption (33.3%), followed by fidelity (28.6%), appropriateness (19.0%), sustainability (9.5%), acceptability (4.8%), and cost (4.8%). No studies measured feasibility or penetration. Although various implementation strategies have been utilized, most of them are under the categories related to intervention methods. Less attention has been paid to strategies that aim at structural changes of intervention delivery systems. Future studies should investigate facilitators and barriers of implementing music-based interventions especially focusing on organizational and structural aspects.

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Factors determining eligibility and access to subacute rehabilitation for elderly people with dementia and hip fracture

Dementia ◽

10.1177/1471301215599704 ◽

2015 ◽

Vol 16 (4) ◽

pp. 413-423 ◽

Cited By ~ 9

Author(s):

Rosemary A McFarlane ◽

Stephen T Isbel ◽

Maggie I Jamieson

Keyword(s):

Hip Fracture ◽

Best Practice ◽

Inpatient Rehabilitation ◽

Models Of Care ◽

Cochrane Library ◽

Ageing Population ◽

Barriers To Access ◽

People With Dementia ◽

Vulnerable Patients ◽

The Cochrane Library

With hip fracture and dementia increasing in incidence in the global ageing population, there is a need for the development of specific procedures targeting optimal treatment outcomes for these patients. This paper looks primarily at the factors that limit access to subacute rehabilitation services as a growing body of evidence suggests that access to timely inpatient rehabilitation increases functional outcomes for patients both with dementia and without. Information was gathered by searching electronic data bases (SCOPUS, Medline, CINAHL, Health Source Nursing/Academic Addition, Psychinfo and the Cochrane Library) for relevant articles using the search terms dementia OR Alzheimer* AND hip fracture AND subacute rehabilitation OR convalescence for the period 2005–2015. Abstracts were scanned to identify articles discussing eligibility and access. A total of nine papers were identified that directly addressed this topic. Other papers discussing success or failure of rehabilitation and improved models of care were also reviewed. Barriers to access discussed in the literature include information management, management of comorbidities, attitudes, resource availability, and the quality of evidence and education. By identifying these factors we can identify strategic points of intervention across the trajectory of prevention, treatment and rehabilitation that may improve outcomes for this growing group of vulnerable patients. Emerging best practice for these patients is also discussed.

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Increasing enjoyable activities to treat depression in nursing home residents with dementia: A pilot study

Dementia ◽

10.1177/1471301215586069 ◽

2016 ◽

Vol 16 (2) ◽

pp. 204-218 ◽

Cited By ~ 5

Author(s):

Catherine Travers

Keyword(s):

Nursing Home ◽

Pilot Study ◽

Nursing Home Residents ◽

Significant Treatment ◽

Qualitative Feedback ◽

Intervention Measures ◽

People With Dementia ◽

Moderate Dementia ◽

University Of Louisville ◽

The University

This pilot study aimed to assess the feasibility and acceptability of a behavioral activities intervention (BE-ACTIV) in Australian nursing homes. BE-ACTIV was developed by researchers at the University of Louisville, USA, to improve mood and quality of life (QOL) in nursing home residents with mild to moderate dementia. An eight-week trial was conducted and 10 residents with mild to moderate dementia received the BE-ACTIV intervention while eight residents received a Walking and Talking intervention. Measures of depression (GDS-12R) and QOL (QOL-AD-NH) were administered prior to and following the interventions. Qualitative feedback indicated residents benefited from BE-ACTIV, evident by improved mood, although no statistically significant treatment effect was found. Moreover, the intervention was found to be feasible and acceptable to Australian nursing home staff and our findings highlight the importance of individualizing activities for people with dementia, of which 1:1 staff attention was a key component.

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A systematic meta-review of self-management support for people with dementia

Dementia ◽

10.1177/1471301218772894 ◽

2018 ◽

Vol 19 (2) ◽

pp. 253-269

Author(s):

Judith G Huis in het Veld ◽

Renate Verkaik ◽

Berno van Meijel ◽

Anneke L Francke

Keyword(s):

Systematic Reviews ◽

Well Being ◽

Self Management ◽

Cochrane Library ◽

Future Research ◽

Management Support ◽

People With Dementia ◽

Literature Searches ◽

Meta Review ◽

The Cochrane Library

Self-management support for people with dementia is important to help them and their family caregivers to cope with challenges in daily live. Insight into the effects of self-management support interventions on people with dementia is however lacking, despite existing relevant systematic reviews. We therefore conducted a meta-review of relevant systematic reviews, following the PRISMA statement. Systematic literature searches were conducted in PubMed, CINAHL, the Cochrane Library, Embase and PsycINFO. The searches were done in December 2015, and all relevant references until then were taken into consideration. No conclusions about the effects of self-management support interventions on people with dementia could be drawn. Recommendations for future research and practice include that self-management support interventions and effect measurements should be wider in scope than psychological well-being.

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Potential of telepresence robots to enhance social connectedness in older adults with dementia: an integrative review of feasibility

International Psychogeriatrics ◽

10.1017/s1041610217001776 ◽

2017 ◽

Vol 29 (12) ◽

pp. 1951-1964 ◽

Cited By ~ 21

Author(s):

Wendy Moyle ◽

Urska Arnautovska ◽

Tamara Ownsworth ◽

Cindy Jones

Keyword(s):

Social Connectedness ◽

Feasibility Studies ◽

Dementia Care ◽

Integrative Review ◽

Cochrane Library ◽

Social Connection ◽

Assistive Robots ◽

People With Dementia ◽

Telepresence Robots ◽

The Cochrane Library

ABSTRACTBackground:Socially assistive robots are increasingly used as a therapeutic tool for people with dementia, as a means to improve quality of life through social connection. This paper presents a mixed-method integrative review of telepresence robots used to improve social connection of people with dementia by enabling real-time communication with their carers.Methods:A systematic search of Medline, ProQuest, PubMed, Scopus, Web of Science, CINAHL, EMBASE, and the Cochrane library was conducted to gather available evidence on the use of telepresence robots, specifically videoconferencing, to improve social connectedness, in people with dementia. A narrative synthesis was used to analyze the included studies.Results:A review of 1,035 records, identified four eligible peer-reviewed publications, reporting findings about three different mobile telepresence robots. The study designs included qualitative and mixed-methods approaches, focusing primarily on examining the feasibility and acceptability of the telepresence robots within the context of dementia care. These studies reported both positive outcomes of using telepresence robots to connect people with dementia to others, as well as barriers, such as a lack of experience in using a robot and technological issues.Conclusion:Although limited, the current literature suggests that telepresence robots have potential utility for improving social connectedness of people with dementia and their carers. However, more systematic feasibility studies are needed to inform the development of telepresence robots followed by clinical trials to establish efficacy within dementia care.

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Measuring social integration among residents in a dementia special care unit versus traditional nursing home: A pilot study

Dementia ◽

10.1177/1471301215594950 ◽

2016 ◽

Vol 16 (3) ◽

pp. 388-403 ◽

Cited By ~ 9

Author(s):

Katherine M Abbott ◽

Justine S Sefcik ◽

Kimberly Van Haitsma

Keyword(s):

Nursing Home ◽

Social Integration ◽

Objective Assessment ◽

Nursing Home Residents ◽

Special Care ◽

Special Care Unit ◽

Physical And Mental Health ◽

People With Dementia ◽

Public Areas ◽

Staff Interactions

The physical and mental health of older adults with dementia is affected by levels of social integration. The development of dementia special care units (D-SCU) arose, in part, to facilitate more meaningful social interactions among residents implying greater social integration of D-SCU residents as compared to residents in a traditional nursing home (TNH). But, it is unknown whether D-SCU residents are receiving equal or greater benefits from living on a segregated unit intended to enhance their social environment and integration through both design and staff involvement. The purpose of this study was to pilot test a comprehensive objective assessment to measure social integration among nursing home residents with dementia and to compare levels of integration of residents living on a D-SCU to those living in a TNH. A total of 29 residents participated (15 D-SCU and 14 TNH) and data were gathered from medical charts, visitor logs, and through direct observations. Over 1700 interactions were recorded during 143 h of observation. Specifically, the location, context, type, quantity, and quality of residents’ interactions were recorded. Overall, the majority of resident interactions were verbal and initiated by staff. Interactions were social in context, and occurred in public areas, such as the common room with a large screen TV. Average interactions lasted less than 1 min and did not change the resident’s affect. Residents spent between 10% and 17% of their time interacting with other people on average. D-SCU staff were significantly more likely to initiate interactions with residents than TNH staff. D-SCU residents also experienced more interactions in the afternoons and expressed more pleasure and anxiety than residents in the TNH. This study helps to lay the groundwork necessary to comprehensively and objectively measure social integration among people with dementia in order to evaluate care environments.

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Identifying behavior change techniques for inclusion in a complex intervention targeting antipsychotic prescribing to nursing home residents with dementia

Translational Behavioral Medicine ◽

10.1093/tbm/ibaa053 ◽

2020 ◽

Author(s):

Kieran A Walsh ◽

Suzanne Timmons ◽

Stephen Byrne ◽

John Browne ◽

Jenny Mc Sharry

Keyword(s):

Nursing Home ◽

Behavior Change ◽

Complex Intervention ◽

Mode Of Delivery ◽

Nursing Home Residents ◽

Intervention Development ◽

Behavior Change Techniques ◽

People With Dementia ◽

Increased Risk ◽

Antipsychotic Prescribing

Abstract Nursing home residents with dementia are commonly prescribed antipsychotics despite the associated increased risk of harms. Interventions to optimize prescribing practice have been found to be effective in the short term, but there is a lack of evidence to support sustainability of effects, along with a lack of theory, public involvement, and transparency in the intervention development process. Using theory has been advocated as a means of improving intervention sustainability. The aim of this study was, therefore, to identify behavior change techniques (BCTs) for inclusion in a complex intervention targeting antipsychotic prescribing to nursing home residents with dementia. A comprehensive approach to identifying a long list of all potential BCTs from three different sources was undertaken. The most appropriate BCTs were then selected through a two-round Delphi consensus survey with a broad range of experts (n = 18 panelists). Advisory groups of people with dementia, family carers, and professional stakeholders provided feedback on the final BCTs included. After two Delphi survey rounds, agreement was reached on 22 BCTs. Further refinement of the selected BCTs based on advisory group and panelists’ feedback, along with use of the APEASE criteria (Affordability, Practicability, Effectiveness, Acceptability, Side effects/safety, and Equity) resulted in a final list of 16 BCTs. The next step in intervention development will be to identify the most appropriate mode of delivery of the 16 BCTs identified for inclusion. The study provides a case example of a systematic approach to incorporating evidence with stakeholder views in the identification of appropriate BCTs.

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Characteristics of multicomponent, nonpharmacological interventions to reduce or avoid sleep disturbances in nursing home residents: a systematic review

International Psychogeriatrics ◽

10.1017/s1041610220000733 ◽

2020 ◽

pp. 1-29 ◽

Cited By ~ 1

Author(s):

Denise Wilfling ◽

Jonas Hylla ◽

Almuth Berg ◽

Gabriele Meyer ◽

Sascha Köpke ◽

...

Keyword(s):

Systematic Review ◽

Nursing Home ◽

Sleep Disturbances ◽

Light Exposure ◽

Complex Interventions ◽

Nursing Home Residents ◽

Cochrane Library ◽

Controlled Trials ◽

Positive Effects ◽

Multicomponent Interventions

ABSTRACT Background: Dementia guidelines propose the use of nonpharmacological interventions for sleep disturbances for older people. Based on available reviews, it seems most likely that multicomponent interventions have the strongest potential to be effective in improving sleep. However, a detailed description of multicomponent interventions is missing. This systematic review aims to identify, describe, and summarize multicomponent, nonpharmacological interventions to reduce or avoid sleep disturbances in nursing home residents. Methods: This review followed established methodological frameworks for systematic evidence syntheses. A computerized search was conducted in December 2018, using the databases PubMed, CINAHL, Scopus, and Cochrane Library. Two independent reviewers assessed all search results to identify eligible studies and assessed studies’ methodological quality following the Cochrane Risk of Bias methodology for randomized controlled trials and the CASP Appraisal Checklist for controlled trials. Evaluation studies of any design investigating multicomponent interventions were included, except case studies. Components of included intervention programs were analyzed applying the TIDieR and CReDECI 2 criteria. Results: A total of 2056 studies were identified through the database search; ten publications about nine interventions met the inclusion criteria and were included in the review. The identified interventions can be summarized assigned to the categories “daytime activities,” “nighttime activities,” “staff training,” and “light exposure.” The approaches showed similarities and differences in procedures, materials, modes of delivery, intervention provider, and intervention period. None of the studies described any intended interactions between components or considered context characteristics in intervention modeling as well as internal and external facilitators or barriers influencing delivery of intervention. We identified positive or mixed positive effects for sleep-related outcomes for the mentioned categories. Conclusions: The analysis of included interventions demonstrates somehow promising results, although findings are difficult to interpret as interventions were not well described, and the challenges of developing and evaluating complex interventions were not sufficiently acknowledged.

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Quality of dying of nursing home residents with dementia as judged by relatives

International Psychogeriatrics ◽

10.1017/s1041610213000756 ◽

2013 ◽

Vol 25 (10) ◽

pp. 1697-1707 ◽

Cited By ~ 15

Author(s):

Nicole van Uden ◽

Lieve Van den Block ◽

Jenny T. van der Steen ◽

Bregje D. Onwuteaka-Philipsen ◽

An Vandervoort ◽

...

Keyword(s):

Nursing Home ◽

Quality Of Care ◽

Retrospective Study ◽

Nursing Homes ◽

The Netherlands ◽

Nursing Home Residents ◽

Quality Of Dying ◽

People With Dementia ◽

Number Of Patients

ABSTRACTBackground:Providing good quality care for the growing number of patients with dementia is a major challenge. There is little international comparative research on how people with dementia die in nursing homes. We compared the relative's judgment on quality of care at the end of life and quality of dying of nursing home residents with dementia in Belgium and the Netherlands.Methods:This was a Belgian cross-sectional retrospective study (2010) combined with a prospective and retrospective study from the Netherlands (January 2007–July 2011). Relatives of deceased residents of 69 Belgian and 34 Dutch nursing homes were asked to complete questionnaires. We included 190 and 337 deceased nursing home residents with dementia in Belgium and the Netherlands, respectively.Results:Of all identified deceased nursing home residents with dementia, respectively 53.2% and 74.8% of their relatives in Belgium and the Netherlands responded. Comfort while dying (CAD-EOLD, range 14–42) was rated better for Dutch nursing home residents than for Belgian nursing homes residents (26.1 vs. 31.1, OR 4.5, CI 1.8–11.2). We found no differences between countries regarding Satisfaction With Care (SWC-EOLD, range 10–40, means 32.5 (the Netherlands) and 32.0 (Belgium)) or symptom frequency in the last month of life (SM-EOLD, range 0–45, means 26.4 (the Netherlands) and 27.2 (Belgium)).Conclusion:Although nursing home structures differ between Belgium and the Netherlands, the quality of care in the last month of life for residents with dementia is similar according to their relatives. However, Dutch residents experience less discomfort while dying. The results suggest room for improved symptom management in both countries and particularly in the dying phase in Belgium.

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Diurnal Variation of Cortisol in People With Dementia: Relationship to Cognition and Illness Burden

American Journal of Alzheimer s Disease & Other Dementias® ◽

10.1177/1533317510397329 ◽

2011 ◽

Vol 26 (2) ◽

pp. 145-150 ◽

Cited By ~ 11

Author(s):

Christine R. Kovach ◽

Diana Lynn Woods ◽

Brent R. Logan ◽

Hershel Raff

Keyword(s):

Older Adults ◽

Nursing Home ◽

Diurnal Rhythm ◽

Nursing Home Residents ◽

Negative Slope ◽

Diurnal Pattern ◽

Biological Mechanisms ◽

Illness Burden ◽

People With Dementia ◽

Flat Profile

Cortisol patterns in nursing home residents with dementia are described and examined in relation to cognition and comorbid illnesses. Saliva was sampled 4 times in a 24-hour period (week 1) and at the same times 1 week later (week 2). In general, cortisol levels decreased from morning to evening, with 50% exhibiting a negative slope. In contrast, 38% of the participants had a relatively flat cortisol diurnal rhythm, and 7% exhibited an afternoon increase. The cortisol pattern was consistent between weeks 1 and 2 for 39% with a negative slope, 13% with a flat profile, and for 2% with an afternoon increase pattern. Cortisol rhythm was not statistically significantly related to cognition or illness burden. While this study contributes to the understanding of differences in the diurnal pattern of cortisol for older adults with dementia, more research is needed to understand the etiology of the differences and the biological mechanisms involved.

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A Tablet ‐ Based Intervention for Activating Nursing Home Residents with Dementia: Results from a Cluster-Randomised Controlled Trial

10.21203/rs.3.rs-66724/v2 ◽

2021 ◽

Author(s):

Julie Lorraine O'Sullivan ◽

Sonia Lech ◽

Paul Gellert ◽

Ulrike Grittner ◽

Jan-Niklas Voigt-Antons ◽

...

Keyword(s):

Quality Of Life ◽

Nursing Home ◽

Nursing Homes ◽

Psychotropic Medication ◽

Controlled Trial ◽

Depression Scale ◽

Nursing Home Residents ◽

Pharmacological Intervention ◽

People With Dementia

Abstract Objectives: To investigate global and momentary effects of a tablet-based non-pharmacological intervention for nursing home residents living with dementia.Design: Cluster-randomized controlled trial.Setting: Ten nursing homes in Germany were randomly allocated to the tablet-based intervention (TBI, 5 units) or conventional activity sessions (CAS, 5 units).Participants: N = 162 residents with dementia. Intervention: Participants received regular TBI (n = 80) with stimulating activities developed to engage people with dementia or CAS (n = 82) for eight weeks.Measurements: Apathy Evaluation Scale (AES-I, primary outcome), Quality of Life in Alzheimer’s Disease scale, QUALIDEM scale, Neuropsychiatric Inventory, Geriatric Depression Scale and psychotropic medication (secondary outcomes). Momentary quality of life was assessed before and after each activity session. Participants and staff were blinded until collection of baseline data was completed. Data was analyzed with linear mixed-effects models.Results: Levels of apathy decreased slightly in both groups (mean decrease in AES-I of .61 points, 95%CI: -3.54 to 2.33 for TBI and .36 points, 95%CI: -3.27 to 2.55 for CAS). Group difference in change of apathy was not statistically significant (B = .25; 95%CI: -3.89 to 4.38, p = .91). This corresponds to a standardized effect size (Cohen’s d) of .02. A reduction of psychotropic medication was found for TBI compared to CAS. Further analyses revealed a post-intervention improvement in QUALIDEM scores across both groups and short-term improvements of momentary quality of life in the CAS group.Conclusions: Our findings suggest that interventions involving tailored activities have a beneficial impact on global and momentary quality of life in nursing home residents with dementia. Although we found no clear advantage of TBI compared to CAS, tablet computers can support delivery of non-pharmacological interventions in nursing homes and facilitate regular assessments of fluctuating momentary states. Funding: German National Association of Statutory Health Insurance Funds. Registry: ISRCTN98947160.

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