Browse > Article
http://dx.doi.org/10.4040/jkan.2016.46.4.475

Stimulation-Oriented Interventions for Behavioral Problems among People with Dementia: A Systematic Review and Meta-Analysis  

Kim, Eun Young (Department of Psychotherapy, College of Nursing and Public Health, Kyungil University)
Hwang, Sung-Dong (Department of Social Welfare, College of Social Science, Kyungpook National University)
Kim, Eun Joo (Department of Nursing, College of Health and Medical Science, Daejeon University)
Publication Information
Journal of Korean Academy of Nursing / v.46, no.4, 2016 , pp. 475-489 More about this Journal
Abstract
Purpose: This study was a systematic review and meta-analysis designed to investigate the effects of stimulation-oriented interventions for behavioral problems among people with dementia. Methods: Based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), a literature search was conducted using seven electronic databases, gray literature, and other sources. Methodological quality was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) for randomized controlled trials (RCTs). Data were analyzed using R with the 'meta' package and the Comprehensive Meta-Analysis (CMA 2.0) program. Results: Sixteen studies were included for meta-analysis to investigate the effect of stimulation-oriented interventions. The quality of individual studies was rated as '++' for eight studies and '+' for the rest. The effect sizes were analyzed according to three subgroups of interventions (light, music, and others); Hedges' g=0.04 (95% CI: -0.38~0.46), -0.23 (95% CI: -0.56~0.10), -0.34 (95% CI: -0.34~0.00), respectively. To explore the possible causes of heterogeneity ($I^2=62.8%$), meta-regression was conducted with covariates of sample size, number of sessions, and length of session (time). No moderating effects were found for sample size or number of sessions, but session time showed a significant effect (Z=1.96, 95% CI: 0.00~0.01). Finally, a funnel plot along with Egger's regression test was performed to check for publication bias, but no significant bias was detected. Conclusion: Based on these findings, stimulation-oriented interventions seem to have a small effect for behavioral problems among people with dementia. Further research is needed to identify optimum time of the interventions for behavioral problems among dementia pateints.
Keywords
Dementia; Behavioral symptoms; Sensory art therapies; Acoustic stimulation; Meta-analysis;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Talerico KA, Evans LK, Strumpf NE. Mental health correlates of aggression in nursing home residents with dementia. The Gerontologist. 2002;42(2):169-177. http://dx.doi.org/10.1093/geront/42.2.169   DOI
2 Cohen-Mansfield J, Billig N. Agitated behaviors in the elderly. I. A conceptual review. Journal of the American Geriatrics Society. 1986;34(10):711-721. http://dx.doi.org/10.1111/j.1532-5415.1986.tb04302.x   DOI
3 Rabins PV, Rovner BW, Rummans T, Schneider LS, Tariot PN. Guideline watch (October 2014): Practice guideline for the treatment of patients with Alzheimer's disease and other dementias. Arlington, VA: American Psychiatric Association; 2014. p. 1-26.
4 Rabins PV, Blacker D, Rovner BW, Rummans T, Schneider LS, Tariot PN, et al. Practice guideline for the treatment of patients with Alzheimer' disease and other dementias. 2nd ed. Arlington, VA: American Psychiatric Association; 2007. p. 1-86.
5 Harbour R, Miller J. A new system for grading recommendations in evidence based guidelines. BMJ: British Medical Journal., 2001; 323(7308):334-336.http://dx.doi.org/10.1136/bmj.323.7308.334   DOI
6 Hwang SD. Meta analysis. Seoul: Hakjisa Corp.; 2014. p. 1-318.
7 Ministry of Health & Welfare. National dementia strategy 2013-2015[Internet]. Seoul: Author; 2012[cited 2012 July 27]. Available from: http://www.silverweb.or.kr/_data/board_list_file/1/2012/1207301339541.pdf.
8 Kong EH, Evans LK, Guevara JP. Nonpharmacological intervention for agitation in dementia: A systematic review and meta-analysis. Aging & Mental Health. 2009;13(4):512-520. http://dx.doi.org/10.1080/13607860902774394   DOI
9 Kong EH, Park M. Effects of music therapy on agitation in dementia: Systematic review and meta-analysis. Korean Journal of Adult Nursing. 2015;27(1):106-116. http://dx.doi.org/10.7475/kjan.2015.27.1.106   DOI
10 Brodaty H, Arasaratnam C. Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. The American Journal of Psychiatry. 2012;169(9):946-953. http://dx.doi.org/10.1176/appi.ajp.2012.11101529   DOI
11 Scottish Intercollegiate Guidelines Network. SIGN 50: A guideline developer' handbook[Internet]. Edinburgh, UK: Author; 2011 [cited 2014 November 20]. Available from: http://www.sign.ac.uk/guidelines/fulltext/50/index.html.
12 Cooke ML, Moyle W, Shum DH, Harrison SD, Murfield JE. A randomized controlled trial exploring the effect of music on agitated behaviours and anxiety in older people with dementia. Aging & Mental Health. 2010;14(8):905-916. http://dx.doi.org/10.1080/13607861003713190   DOI
13 Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to meta-analysis. Chichester, UK: John Wiley & Sons, Ltd; 2009. p. 1-452.
14 Schwarzer G. Meta: General package for meta-analysis. R package version 4.3-2[Internet]. Berkeley, CA: The Comprehensive R Archive Network; 2015[cited 2015 December 2]. Available from: https://cran.r-project.org/web/packages/meta/index.html.
15 Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988. p. 1-567.
16 Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0[Internet]. London, UK: The Cochrane Collaboration; 2011[cited 2011 March 2]. Available from: http://handbook.cochrane.org/.
17 Littell JH, Corcoran J, Pillai V. Systematic reviews and meta-analysis. New York, NY: Oxford University Press; 2008.
18 Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ: British Medical Journal. 1997;315(7109):629-634. http://dx.doi.org/10.1136/bmj.315.7109.629   DOI
19 Baker R, Bell S, Baker E, Gibson S, Holloway J, Pearce R, et al. A randomized controlled trial of the effects of multi-sensory stimulation (MSS) for people with dementia. The British Journal of Clinical Psychology. 2001;40(Pt 1):81-96. http://dx.doi.org/10.1348/014466501163508   DOI
20 Raglio A, Bellelli G, Traficante D, Gianotti M, Ubezio MC, Gentile S, et al. Efficacy of music therapy treatment based on cycles of sessions: A randomised controlled trial., Aging & Mental Health. 2010;14(8) :900-904. http://dx.doi.org/10.1080/13607861003713158   DOI
21 Ueda T, Suzukamo Y, Sato M, Izumi S. Effects of music therapy on behavioral and psychological symptoms of dementia: A systematic review and meta-analysis. Ageing Research Reviews. 2013;12 (2):628-641. http://dx.doi.org/10.1016/j.arr.2013.02.003   DOI
22 Livingston G, Kelly L, Lewis-Holmes E, Baio G, Morris S, Patel N, et al. Non-pharmacological interventions for agitation in dementia: Systematic review of randomised controlled trials. The British Journal of Psychiatry. 2014;205(6):436-442. http://dx.doi.org/10.1192/bjp.bp.113.141119   DOI
23 Cabrera E, Sutcliffe C, Verbeek H, Saks K, Soto-Martin M, Meyer G, et al. Non-pharmacological interventions as a best practice strategy in people with dementia living in nursing homes. A systematic review. European Geriatric Medicine. 2015;6(2):134-150. http://dx.doi.org/10.1016/j.eurger.2014.06.003   DOI
24 Yury CA, Fisher JE. Meta-analysis of the effectiveness of atypical antipsychotics for the treatment of behavioural problems in persons with dementia. Psychotherapy and Psychosomatics. 2007;76(4): 213-218. http://dx.doi.org/10.1159/000101499   DOI
25 Slone DG, Gleason CE. Behavior management planning for problem behaviors in dementia: A practical model. Professional Psychology. 1999;30(1):27-36. http://dx.doi.org/10.1037/0735-7028.30.1.27   DOI
26 Medical World News. During past 5 years number of dementia patients increased 17% and missing rates increased 80%[Internet]. Seoul: Author; 2013[cited 2013 April 19]. Available from: http://medicalworldnews.co.kr/news/view.php?newsid=1366370094.
27 Schneider LS, Dagerman K, Insel PS. Efficacy and adverse effects of atypical antipsychotics for dementia: Meta-analysis of randomized, placebo-controlled trials. The American Journal of Geriatric Psychiatry. 2006;14(3):191-210. http://dx.doi.org/10.1097/01.JGP.0000200589.01396.6d   DOI