Guidelines for psychosocial interventions in dementia care: A European survey and comparison

Scientific Institute for Quality of Healthcare and Nijmegen Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
International Journal of Geriatric Psychiatry (Impact Factor: 2.87). 01/2012; 27(1):40-8. DOI: 10.1002/gps.2687
Source: PubMed


The effectiveness of psychosocial interventions in treating people with dementia and their carers is increasingly emphasised in the literature. Dementia guidelines should summarise the scientific evidence and best practice that is currently available, therefore, it should include recommendations for psychosocial interventions. The aims of our study were (1) to collate dementia guidelines from countries across Europe and to check whether they included sections about psychosocial interventions, and (2) to compare the methodological quality and the recommendations for specific psychosocial interventions in these guidelines.
The European dementia guidelines were inventoried. The methodological quality of the guideline sections for psychosocial interventions was assessed with the (AGREE) Appraisal of Guidelines Research and Evaluation instrument. The recommendations for specific psychosocial interventions were extracted from each of these guidelines and compared.
Guidelines for psychosocial interventions were found in five of 12 countries. Guideline developers, methodological quality and appreciation of available evidence influenced the inclusion of psychosocial interventions in dementia guidelines from Germany, Italy, the Netherlands, Spain and the UK. The UK NICE SCIE guideline had the best methodological quality and included the most recommendations for psychosocial interventions. Physical activity and carer interventions were recommended the most across all guidelines.
The inclusion of psychosocial interventions in dementia guidelines is limited across Europe. High-quality guidelines that include psychosocial interventions and are kept up to date with the emerging evidence are needed. Throughout Europe, special attention to the implementation of evidence-based psychosocial care is needed in the next few years.

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    • "Considering all these, providing services for people with dementia has been recognized as a major public health priority in the UK and worldwide (Brookmeyer, Gray & Kawas, 1998; Banerjee, Willis, Mathews, Contell, Chan & Murray, 2007). There is an increasingly higher recognition in the literature, related to the fact that, psychosocial interventions make an essential contribution in dementia care and they are effective also in terms of costs (Knapp et al., 2006; Vasse et al., 2012). Most of these psychosocial interventions aim to improve: cognitive abilities, behavior, mood or quality of life. "
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    ABSTRACT: There is a high recognition of the fact that psychosocial interventions make an essential contribution in dementia care. However, the evidence for specific psychosocial interventions are mixed and limited yet. Therefore, we performed a meta-analysis of the relevant literature, to investigate the effectiveness of psychosocial interventions focused on improvements in cognition, behavior, mood and quality of life. To select the 10 studies included in the meta-analysis, we conducted an extensive search in the following databases: MEDLINE, PsychINFO, EBSCO, WEB OF SCIENCE. The results we obtained show that psychosocial interventions in dementia for cognitive abilities are effective, even if the effect size is low.
    Full-text · Article · Apr 2014 · Procedia - Social and Behavioral Sciences
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    • "Concerning the implementation of guidelines for psychosocial interventions in dementia care, a comparison of seven European guidelines, including the German version, showed weaknesses in their applicability [15]. The latest review on nonpharmacological interventions concluded that the feasibility of the investigated interventions is limited because of resource requirements [16]. "
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    ABSTRACT: In Germany, the number of people with dementia living in nursing homes is rapidly increasing. Providing adequate care for their special needs is a challenge for institutions and their staff members. Because of the growing number of people with dementia, changes to the conceptual orientation of nursing homes have occurred. These changes include specialized living arrangements and psychosocial interventions recommended for people with dementia. Until now, the provision of dementia care and its association to the residents' behavior and quality of life is not well investigated in Germany. The purpose of this study is to describe the provision of dementia care and to identify resident- as well as facility-related factors associated with residents behavior and quality of life. The DemenzMonitor study is designed as a longitudinal study that is repeated annually. Data will be derived from a convenience sample consisting of nursing homes across Germany. For the data collection, three questionnaires have been developed that measure information on the level of the nursing home, the living units, and the residents. Data collection will be performed by staff members from the nursing homes. The data collection procedure will be supervised by a study coordinator who is trained by the research team. Data analysis will be performed on each data level using appropriate techniques for descriptions and comparisons as well as longitudinal regression analysis. The DemenzMonitor is the first study in Germany that assesses how dementia care is provided in nursing homes with respect to living arrangements and recommended interventions. This study links the acquired data with residents' outcome measurements, making it possible to evaluate different aspects and concepts of care.
    Full-text · Article · Nov 2013 · BMC Geriatrics
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    • "Psychosocial interventions have shown to have positive effects and the use of these interventions in dementia care are included in European dementia guidelines [30] including two Dutch guidelines [31,32]. Physicians serve as gatekeepers and are in the position to provide clients and caregivers with access to psychosocial services using referrals. "
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    ABSTRACT: To evaluate the effectiveness of a multifaceted implementation strategy on physicians’ referral rate to and knowledge on the community occupational therapy in dementia program (COTiD program). A cluster randomized controlled trial with 28 experimental and 17 control clusters was conducted. Cluster included a minimum of one physician, one manager, and two occupational therapists. In the control group physicians and managers received no interventions and occupational therapists received a postgraduate course. In the experimental group physicians and managers had access to a website, received newsletters, and were approached by telephone. In addition, physicians were offered one outreach visit. In the experimental group occupational therapists received the postgraduate course, training days, outreach visits, regional meetings, and access to a reporting system. Main outcome measure was the number of COTiD referrals received by each cluster which was assessed at 6 and 12 months after the start of the intervention. Referrals were included from both participating physicians (enrolled in the study and received either the control or experimental intervention) and non-participating physicians (not enrolled but of whom referrals were received by participating occupational therapists). Mixed model analyses were used to analyze the data. All analyses were based on the principle of intention-to-treat. At 12 months experimental clusters received significantly more referrals with an average of 5,24 referrals (SD 5,75) to the COTiD program compared to 2,07 referrals in the control group (SD 5,14). The effect size at 12 months was 0.58. Although no difference in referral rate was found for the physicians participating in the study, the number of referrals from non-participating physicians (t −2,55 / 43 / 0,02) differed significantly at 12 months. Passive dissemination strategies are less likely to result in changes in professional behavior. The amount of physicians exposed to active strategies was limited. In spite of this we found a significant difference in the number of referrals which was accounted for by more referrals of non-participating physicians in the experimental clusters. We hypothesize that the increase in referrals was caused by an increase in occupational therapists’ efforts to promote their services within their network. Trial registration NCT01117285
    Full-text · Article · May 2013 · BMC Family Practice
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