Degree of personalisation in tailored activities and its effect on behavioural and psychological symptoms and quality of life among people with dementia: a systematic review and meta-analysis

Non-pharmacological interventions to reduce neuropsychiatric symptoms in hospitalised patients for behavioural crises with cognitive impairment: A systematic review

Non-pharmacological interventions are pivotal to reducing neuropsychiatric symptoms (NPS) in patients with cognitive impairment. This systematic review assessed the effectiveness of non-pharmacological interventions applicable by nursing staff to reduce NPS in older patients with cognitive impairment hospitalised for behavioural crises. Six databases were searched for randomised or non-randomised controlled trials. Two authors screened full-texts and assessed the quality of the studies using the Modified Downs and Black Checklist. Results were presented narratively using the PRISMA guideline. Only five studies could be included, all were conducted in geriatric psychiatry. Three studies showed significant effects on NPS. They tested physical exercise, behavioural activation for meaningful activity and listening to individualised music and were of good, moderate and low quality, respectively. The best evidence was found for physical exercise. Due to the small number of studies with heterogeneous quality, the results must be interpreted with caution, limiting the scope of conclusions. While more research is needed, we recommend that non-pharmacological interventions in clinical practice be adjusted to patient characteristics, contextual factors and existing care practices.

Adapting "Listen N Talk": Developing a Personalized Communication App with Culturally and Linguistically Diverse Residents in Aged Care

Background

Rich communication between staff and residents in aged care settings is essential. Digital communication devices used to support communication in aged care settings are often not well targeted to individual needs and contexts. In this pilot study, we investigate the adaptation of a phrase-based language learning app, to support communication between carestaff and residents in a residential aged care setting in Western Sydney, Australia.

Methods

An interdisciplinary team of researchers and aged care professionals worked with three aged care residents for whom English was not their first language, to co-design and trial a prototype digital language resource. Insights from carestaff members into communication issues they face in their roles were documented through focus group sessions. A database of phrases was developed and then loaded into the Listen N Talk app. Carestaff trialed the resource with the residents for six weeks. Feedback from carestaff was gathered through semi-structured interviews.

Results

Based on responses of carestaff to an initial focus group, the language content of the prototype was focused on the context of daily care. The residents who participated in the study were long-term residents already familiar with the daily routine of the facility and staff had already established communication strategies regarding residents' needs or preferences. Three contexts were identified in which an app of this kind could be useful to facilitate communication: in a medical emergency, as a tool to strengthen English language skills of residents and staff and in the transition to residential aged care to support the development of routines with the new resident.

Conclusion

This study identified three contexts in which a phrase-based app can facilitate communication with culturally and linguistically diverse residents and carestaff. Feedback suggested avenues for further development such as the use of more open-ended translation together with sets of personalized phrases.

The relationship between perceived engagement in meaningful activity and behavioral and psychological symptoms of dementia among assisted living residents

The purpose of this study is to assess the relationship between engagement in meaningful activities and behavioral and psychological symptoms of dementia (BPSD), including agitation, apathy, irritability, and depression among 71 assisted living (AL) residents with moderate to severe dementia. This secondary analysis used baseline data from a randomized controlled trial, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD) in five AL communities. The Engagement in Meaningful Activities Scale and the Neuropsychiatric Inventory Questionnaire were completed. Logistic regression was used to compare those with and without each BPSD symptom of interest on engagement in meaningful activities while controlling for age, sex, and cognitive impairment. On average, participants were 85 years old, white, females. Perceived engagement in meaningful activities was significantly associated with decreased odds of having agitation (OR=0.94, 95 % CI [.88-0.99]) but not with apathy, depression, or irritability. Engagement in meaningful activities may help reduce agitation among AL residents.

Pharmacist interventions in Asian healthcare environments for older people: a systematic review and meta-analysis on hospitalization, mortality, and quality of life

BACKGROUND

Pharmaceutical interventions play a key role in the care of older people experiencing polypharmacy. Despite the rapid increase in the aging population in Asia, there is a lack of evidence regarding the effectiveness of pharmacist interventions on older adult's healthcare. This systematic review and meta-analysis assessed the effects of pharmacist interventions in Asian health care environments on hospitalization, mortality, and quality of life (QoL) among older people in Asia.

METHODS

A comprehensive search was conducted across 5 databases, encompassing studies published from inception through June 2023. Only studies involving pharmacist interventions for people aged 65 years or older, residing in Asian countries, were considered. Studies without evidence of pharmacist involvement or conducted outside of Asia were excluded. Data extraction was performed by two reviewers, one reviewer (I.K.) performed the initial extraction, and another reviewer (G.R.) verified the extracted data. Forest plots were generated using a random effects model to obtain risk ratios or pooled standardized mean differences (SMDs).

RESULTS

A total of 170 articles underwent thorough review, and ultimately, ten studies meeting the inclusion criteria were included in the meta-analyses. These studies encompassed diverse healthcare settings such as outpatient, inpatient, and nursing homes, with sample sizes ranging from 32 to 306 older people. Pharmacist interventions were found to significantly reduce hospitalization rates (n = 5, risk ratio = 0.57, 95% CI = 0.41-0.81) and mortality rates (n = 4, risk ratio = 0.57, 95% CI = 0.37-0.88) among older people. The analysis revealed less significant improvement in QoL in these patients than in those receiving usual care (n = 6, SMD = 0.36, P = 0.057).

CONCLUSIONS

These findings highlight the crucial role of pharmacists within healthcare teams in Asian countries. Pharmacist interventions have an impact on reducing hospitalization and mortality rates among the elderly people, underscoring the importance of optimizing patient outcomes in Asia.

Effectiveness of Robot Interventions for Cognitive and Psychological Outcomes among Older Adults with Cognitive Impairment: A Meta-Analysis

This review was performed to evaluate the effects of robot interventions on cognitive and psychological outcomes among older adults with cognitive impairment. Three databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) were searched for studies published in English between January 2015 and August 2021. We included studies that involved older adults with cognitive impairment, interventions using robots, outcome measures related to cognitive and psychological status, and randomized controlled trials. Ten studies included in the systematic review, and nine studies derived from these ten articles were included in the meta-analyses. The meta-analyses revealed that robot interventions significantly decreased anxiety and agitation but exerted no significant effects on cognitive function, neuropsychiatric symptoms, and quality of life. The subgroup analyses according to robot types revealed that pet-type robot interventions reduced anxiety and agitation. In addition, subgroup analysis according to the intervention format of robot interventions found that individual intervention was effective for improving agitation, but a group-based intervention was effective for improving depression. We suggest using robot interventions to improve psychological outcomes such as anxiety and agitation; however, further research is needed to determine whether robot interventions affect symptoms such as cognitive function, neuropsychiatric symptoms, and quality of life.

Effective nursing interventions in ADL care affecting independence and comfort - a systematic review

Despite its frequent provision, evidence of nursing interventions in Activities of Daily Living (ADL) remains unclear. Hence, we addressed the research question: What are the effects of ADL nursing interventions on independence and comfort in adults across all care settings? We conducted a systematic review of randomized controlled trials and quasi-experimental studies described in systematic reviews. In three databases, we searched for systematic reviews that we used as a portal to select (quasi) experimental studies. After narratively summarizing the studies on characteristics, effects, and interventions, we assessed the risk of bias. Among the 31 included studies, 14 studies evaluated independence, 14 studies measured comfort, and three studies assessed both outcomes. Seven interventions significantly improved independence and seven interventions significantly improved comfort. The studies varied highly in intervention components, outcome measures, and quality. Evidence on ADL nursing interventions affecting independence and comfort remains fragmented and inconclusive, limiting guidance for nursing professionals.

Non-pharmacological Approaches to Apathy and Depression: A Scoping Review of Mild Cognitive Impairment and Dementia

Apathy and depression are frequently observed as behavioral and psychological symptoms of dementia, respectively, and are important for ensuring adequate care. This study aims to explore effective non-pharmacological interventions for apathy and depression with mild cognitive impairment (MCI) and dementia. Five search engines including PubMed, Scopus, CINAHL, PsycInfo, and Web of Science were used to extract relevant studies. Inclusion criteria were studies that involved participants who were diagnosed with MCI or dementia, included quantitative assessments of each symptom, and employed randomized controlled trials. Twenty studies were extracted, with interventions have been conducted in care facilities, the community, and hospitals. Participants in many studies had MCI or mild-to-moderate dementia but were not diagnosed with the subtypes of dementia. Few studies had set apathy and depression as the primary outcomes of non-pharmacological interventions. The findings suggested that emotional and stimulation-oriented approaches to apathy and depression would be useful for people with MCI or mild-to-moderate dementia. It would be helpful for therapists to assess the clinical features of the target symptoms for selecting suitable interventions. Additionally, increasing the number of randomized controlled trials focusing on apathy or depression as primary outcomes would offer a more definite conclusion for future systematic reviews.