Multisensory stimulation to improve functional performance in moderate to severe dementia--interim results

Effectiveness of Snoezelen in older adults with neurocognitive and other pathologies: A systematic review of the literature

Snoezelen Multisensory Stimulation (SMSS) is a non-pharmacological intervention that provides controlled multisensorial environments to stimulate the primary senses: sight, hearing, smell, touch, taste, proprioceptive and vestibular. Even though the use and potential of SMSS have been widespread in the literature regarding certain target populations (autism, developmental disabilities) and settings (e.g. leisure, therapeutic), its effectiveness in older adults with neurocognitive disorders (e.g. dementia, mild cognitive impairment) and other pathologies (e.g. psychiatric disorders, oncological diseases) is still unclear. Therefore, a systematic review of the literature was conducted to address this issue. The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and of the Cochrane Collaboration were followed. An initial search on PubMed and Scopus databases resulted in 86 articles of which 14 met inclusion criteria and were reviewed in detail. The outcomes showed that most of the studies (n = 13) focused on the effects of SMSS on behaviour and mood in older adults with major cognitive disorders (i.e. dementia). Although there is scarce literature on its impact on cognition, psychophysiological measures (e.g. heart rate, oxygen saturation), daily living functionality and quality of life, this type of intervention seems to contribute to delaying the worsening in severity of the neurocognitive disorders from the mildest to the most severe stages. Likewise, it is legitimate to consider the possibility of potential benefits to older adults with less severe neurocognitive disorders or other pathologies, but more research is needed.

An Auditory Sonic Sleep Treatment for Individuals Living With Dementia in a Memory Care Setting: A Quality Improvement Program Evaluation

BACKGROUND

The absence of a cure for dementia, combined with the increased longevity of the baby boom generation, is resulting in a dramatic increase in the number of people living with dementia. Aging-related changes coupled with dementia-related behavioral symptoms pose unique challenges for those living with dementia as well as those who provide care. There is evidence that improved sleep can improve health and well-being. Research also supports using auditory interventions as a form of nonpharmacological therapy.

OBJECTIVE

This study evaluated the effects of a customized auditory (sonic) treatment during sleep on the mood, behavior, quality of life, functional ability, and health condition of individuals living with the symptoms of dementia. Workforce outcomes were evaluated as a secondary outcome.

METHODS

A controlled before-after design with a mixed-method approach was used to evaluate the impact of the sonic sleep treatment during baseline, intervention, and discontinuation time frames.

RESULTS

Statistically significant improvements were observed in participants' cooperation with care (p = .0249) and daytime drowsiness (p = .0104). Other nonstatistically significant improvements included bed mobility, appetite, bathing self-performance, toilet use, incidence of falls, following requests and instructions, and nighttime insomnia. While workforce outcomes remained unchanged, staff were supportive of resuming the sonic sleep treatment after the discontinuation time frame.

CONCLUSIONS

The sonic sleep treatment demonstrated improved outcomes for individuals living with dementia. This supports using an appropriate auditory stimulus as a fundamental component of care for individuals living in memory care settings.

Effects of multisensory environment/stimulation therapy on adults with cognitive impairment and/or special needs: A systematic review and meta-analysis

AIM

This review aimed to evaluate the effects of multisensory environments/stimulation (MSE/MSS) therapy, on the behavior and psychological symptoms in adults with cognitive impairment and/or special needs.

METHODS

Online database searches were performed to identify studies reporting on the effects of MSS/MSE therapy in adults (>18 years). Data were extracted for the following investigated outcomes including anxiety, depression, mood, behavioral attributes, biomedical parameters, cognition, motor skills, quality of life (QoL), pain, and end of life quality. Two reciprocally blinded investigators extracted the data. Inter-investigator reliability (𝝹) was calculated. A meta-analysis and a qualitative analysis were performed on the information extracted.

RESULTS

Thirty-six studies were included for data extraction and analysis. Meta-analysis of the included studies revealed a significant improvement with the MSE/MSS therapy, for agitation (p = .018), anxiety (p = .023), cognition (p < .001), and depression (p < .001). MSS/MSE therapy demonstrated a tendency for the improvement of the QoL in adults (p = .05).

CONCLUSION

MSE/MSS therapies are beneficial in cognitively impaired adults and improve their anxiety, depression, cognitive and other behavioral attributes such as agitative behaviors. Promoting these therapies in geriatric care may help to improve/reduce the challenging/care-resistant behaviors in adults and facilitate effective provision of the necessary care.

Use of multisensory stimulation in institutionalized older adults with moderate or severe dementia

The Multisensory Stimulation Program can help manage behavioral and psychological symptoms of dementia.

A scoping review: Sensory interventions for older adults living with dementia

This scoping review focused on the existing scholarly literature exploring sensory interventions and immersive environments developed for, and used by, older adults living with dementia. The purpose of the scoping review is 1) to understand the various sensory interventions that have been developed, used, and have provided data to show how such interventions are expected to impact the lives of individuals living with dementia; and 2) to understand how the field is moving forward. We chose to map the literature to understand the types of interventions, the types of outcomes measured, and the contexts of their implementation. Our search was constrained to references from 1990 to 1 June 2019 in the following databases: Academic Search Complete, CINAHL Complete, MEDLINE, PsycINFO databases, and Summon Search discovery layer. We screened 2305 articles based on their titles and abstracts, and 465 were sent to full text review, of which 170 were included in our full text extraction. Once the data were extracted, we created emic categories, which emerged from the data, for data that were amenable to categorization (e.g., study setting, intervention type, and outcome type). We developed ten different categories of interventions: art, aromatics, light, multi-component interventions, multisensory rooms, multisensory, music, nature, touch, and taste. Sensory interventions are a standard psychosocial approach to managing the personal expressions commonly experienced by people living with dementia. Our findings can help providers, caregivers, and researchers better design interventions for those living with dementia, to help them selectively choose interventions for particular outcomes and settings. Two areas emerging in the field are nature interventions (replacing traditional "multisensory rooms" with natural environments that are inherently multisensory and engaging) and multi-component interventions (where cognitive training programs are enhanced by adding sensory components).

Sensory stimulation programs in dementia: a systematic review of methods and effectiveness

INTRODUCTION

Dementia is characterized by the presence of cognitive decline and can lead to sensory-perceptual alterations, compromising the functionality in activities of daily living. The main objective of this work is to review the characteristics of sensory stimulation programs in dementia and its effectiveness.

AREAS COVERED

Studies were identified through a literature search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane Collaboration Guidelines. Twenty studies were included in this review. The studies used multisensory stimulation at different stages of dementia. The results show a lack of consensus regarding frequency, duration, and number of sessions, as well as the duration of the interventions and assessment instruments used to evaluate the results. Multisensory stimulation, particularly Snoezelen, was the most widely used approach. Vision, hearing, touch, and smell were the most frequently stimulated senses. Most studies comprised pre- and post-intervention assessment, but few studies performed follow-up assessment. The interventions that revealed positive results in dementia were Snoezelen, multisensory environment other than Snoezelen, and Multi-sensory Behavior Therapy.

EXPERT OPINION

This review weakly supports sensory stimulation in dementia, providing useful information for rehabilitation and future investigations.

Sensory Environments for Behavioral Health in Dementia: Diffusion of an Environmental Innovation at the Veterans Health Administration

OBJECTIVES

To evaluate the diffusion of multisensory environments (MSEs) as an innovation at the Veterans Health Administration (VHA) and gather feedback regarding staff perceptions of barriers to uptake and effectiveness of MSEs for Veterans with dementia.

BACKGROUND

Responding to the need for nonpharmacological behavioral interventions, VHA funded the first MSE for Veterans with dementia in 2010. The room incorporated LED color-changing lights, bubble tubes, vibroacoustic furniture, music, and aromatherapy, and the success of this patient-centered sensory room fueled national rollouts in 2013 and 2015.

METHOD

A qualitative interview approach was used. Thirty-two staff members participated from 12 of the 53 sites producing 21 individual interviews and 1 group interview with 11 participants. Results were analyzed by a team of eight researchers using the rapid qualitative inquiry method to identify common themes and major insights.

RESULTS

Important insights emerged with regard to staff members' perceptions about the effectiveness of MSE therapy as well as barriers to uptake and suggested strategies for overcoming those barriers (e.g., empowering a champion, developing a clear maintenance plan).

CONCLUSIONS

The findings from this research indicate MSEs are perceived as effective in improving behavior for Veterans with dementia and represent an innovation that has been well-diffused within the VHA, with great potential for future clinical applications.

A group intervention to improve quality of life for people with advanced dementia living in care homes: the Namaste feasibility cluster RCT

BACKGROUND

People with advanced dementia who live and die in nursing homes experience variable quality of life, care and dying. There is a need to identify appropriate, cost-effective interventions that facilitate high-quality end-of-life care provision.

OBJECTIVES

To establish the feasibility and acceptability to staff and family of conducting a cluster randomised controlled trial of the Namaste Care intervention for people with advanced dementia in nursing homes.

DESIGN

The study had three phases: (1) realist review and (2) intervention refinement to inform the design of (3) a feasibility cluster randomised controlled trial with a process evaluation and economic analysis. Clusters (nursing homes) were randomised in a 3 : 1 ratio to intervention or control (usual care). The nature of the intervention meant that blinding was not possible.

SETTING

Nursing homes in England providing care for people with dementia.

PARTICIPANTS

Residents with advanced dementia (assessed as having a Functional Assessment Staging Test score of 6 or 7), their informal carers and nursing home staff.

INTERVENTION

Namaste Care is a complex group intervention that provides structured personalised care in a dedicated space, focusing on enhancements to the physical environment, comfort management and sensory engagement.

MAIN OUTCOME MEASURES

The two contender primary outcome measures were Comfort Assessment in Dying - End of Life Care in Dementia for quality of dying (dementia) and Quality of Life in Late Stage Dementia for quality of life. The secondary outcomes were as follows: person with dementia, sleep/activity (actigraphy), neuropsychiatric symptoms, agitation and pain; informal carers, satisfaction with care at the end of life; staff members, person-centred care assessment, satisfaction with care at the end of life and readiness for change; and other data - health economic outcomes, medication/service use and intervention activity.

RESULTS

Phase 1 (realist review; 86 papers) identified that a key intervention component was the activities enabling the development of moments of connection. In phase 2, refinement of the intervention enabled the production of a user-friendly 16-page A4 booklet. In phase 3, eight nursing homes were recruited. Two homes withdrew before the intervention commenced; four intervention and two control homes completed the study. Residents with advanced dementia (n = 32) were recruited in intervention (n = 18) and control (n = 14) homes. Informal carers (total, n = 12: intervention, n = 5; control, n = 7) and 97 staff from eight sites (intervention, n = 75; control, n = 22) were recruited over a 6-month period. Recruitment is feasible. Completion rates of the primary outcome questionnaires were high at baseline (100%) and at 4 weeks (96.8%). The Quality of Life in Late Stage Dementia was more responsive to change over 24 weeks. Even where economic data were missing, these could be collected in a full trial. The intervention was acceptable; the dose varied depending on the staffing and physical environment of each care home. Staff and informal carers reported changes for the person with dementia in two ways: increased social engagement and greater calm. No adverse events related to the intervention were reported.

CONCLUSIONS

A subsequent definitive trial is feasible if there are amendments to the recruitment process, outcome measure choice and intervention specification.

FUTURE WORK

In a full trial, consideration is needed of the appropriate outcome measure that is sensitive to different participant responses, and of clear implementation principles for this person-centred intervention in a nursing home context.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN14948133.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 6. See the NIHR Journals Library website for further project information.

Digging into the experiences of therapeutic gardening for people with dementia: An interpretative phenomenological analysis

Gardening programmes aim to promote improved engagement and quality of life in persons with dementia. Although a substantial literature has amassed documenting the overall positive outcomes associated with therapeutic gardening and horticulture for persons with dementia, little is known about the specific aspects of the gardening process that engender these benefits, and how and why they are important. The purpose of this research was to explore, using interpretative phenomenological analysis, the experiences of therapeutic gardening for persons with dementia, and their perspectives on the senses and emotions elicited in the gardening process that promote well-being. The themes that emerged in our analysis are to varying degrees substantiated in the literature: the usefulness of activating the senses, particularly those of touch and smell; the significance of being occupied in meaningful, productive work; the importance of cultivating a sense of curiosity, wonder, and learning; the positive gains derived from socialization in a group context; the peace and hope derived from being 'in the moment'; and the positive mental and physical well-being derived from participating in the outdoor garden. Our findings support the integration of therapeutic gardening as a valuable practice for people with dementia.

Impact of Multisensory Environments on Behavior for People With Dementia: A Systematic Literature Review

Purpose of the Study

Behavioral and psychological symptoms of dementia (BPSD) affect quality of life for people with dementia. Nonpharmacological interventions are the preferred first line of treatment, and it is theorized that BPSD are directly influenced by sensory imbalance and improved by sensory equilibrium. The purpose of this article is to investigate the evidence regarding the use of multisensory environments (MSEs) as treatment for BPSD.

Design and Methods

A systematic literature review was performed using the PICO framework within PsycINFO, Web of Science, ERIC, PubMED, and Cinahl databases, as well as additional hand-searched documents. Included articles were published during 1990 to 2015 and report empirical studies of MSE BPSD interventions that include furniture, fixtures, and equipment to provide visual, auditory, tactile, and olfactory stimulation. Desired elements include ergonomic vibroacoustic furniture, bubble tubes, color-changing lights, and fiber optics.

Results

Twelve articles met the inclusion criteria for review. Evidence supports the positive impact of sensory stimulation as a nonpharmacological behavioral treatment for dementia. Many studies investigated both behavior and mood, and several investigated biomedical parameters including heart rate and cognition. Significant differences were not found in the between-group studies when MSE was compared with other one-to-one interventions. Results on long-term effects were mixed. Variations can be seen in terms of research methods, types of environmental interventions, duration, and specific characteristics of participants, thus confounding the reliability of findings.

Implications

Key findings and directions for future research are discussed including primary outcomes, study design, environmental intervention types, and relevant assessment tools.

Improving living and dying for people with advanced dementia living in care homes: a realist review of Namaste Care and other multisensory interventions

BACKGROUND

Seventy percent of people with advanced dementia live and die in care homes. Multisensory approaches, such as Namaste Care, have been developed to improve the quality of life and dying for people with advanced dementia but little is known about effectiveness or optimum delivery. The aim of this review was to develop an explanatory account of how the Namaste Care intervention might work, on what outcomes, and in what circumstances.

METHODS

This is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories, and their validation with a purposive sample of stakeholders. Twenty stakeholders - user/patient representatives, dementia care providers, care home staff, researchers -took part in interviews and/or workshops.

RESULTS

We included 85 papers. Eight focused on Namaste Care and the remainder on other types of sensory interventions such as music therapy or massage. We identified three context-mechanism-outcome configurations which together provide an explanatory account of what needs to be in place for Namaste Care to work for people living with advanced dementia. This includes: providing structured access to social and physical stimulation, equipping care home staff to cope effectively with complex behaviours and variable responses, and providing a framework for person-centred care. A key overarching theme concerned the importance of activities that enabled the development of moments of connection for people with advanced dementia.

CONCLUSIONS

This realist review provides a coherent account of how Namaste Care, and other multisensory interventions might work. It provides practitioners and researchers with a framework to judge the feasibility and likely success of Namaste Care in long term settings. Key for staff and residents is that the intervention triggers feelings of familiarity, reassurance, engagement and connection.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42016047512.

Impact of the design of the built environment on people with dementia: an evidence-based review

OBJECTIVE

In this review the impact of the design of the built environment on people with dementia in long-term care settings is systematically analyzed and summarized. Architects and designers will be provided with credible evidence on which they can confidently base their design decisions. Researchers will be able to determine which environmental aspects have been well investigated and where there are gaps in the current state of the research.

BACKGROUND

A great number of studies have established a relationship between the design of the physical environment of long-term care settings and outcomes of people with dementia. However, the methods employed are heterogeneous and the results are often conflicting. Consequently, the process of integrating the best evidence available into architectural designs may be hindered.

METHODS

A systematic literature search was conducted reviewing studies that meet certain inclusion criteria. Using an evidence-based approach, the methodical quality of the studies was rated.

RESULTS

One hundred sixty-nine studies were found. They were thematically summarized into four main categories: basic design decisions, environmental attributes, ambience, and environmental information. The effectiveness of the interventions on the behavior, cognition, function, well being, social abilities, orientation, and care outcomes on people with dementia was illustrated by matrices.

CONCLUSIONS

Results of this review indicate that, with the exception of cognition, specific design interventions are beneficial to the outcomes of people with dementia. Overall, the field of environmental design for people with dementia is well researched in many aspects and only few gaps in knowledge were identified.

Comparing the Effects of Multisensory Stimulation and Individualized Music Sessions on Elderly People with Severe Dementia: A Randomized Controlled Trial

The objective of this study was to compare the effects of a multisensory stimulation environment (MSSE) and individualized music sessions on agitation, emotional and cognitive status, and dementia severity in a sample of institutionalized patients with severe dementia. Twenty-two participants with a diagnosis of severe or very severe dementia were randomly assigned to two groups: MSSE and individualized music sessions. Both groups participated in two 30-min weekly sessions over 16 weeks. Outcomes were agitation (Cohen-Mansfield Agitation Inventory, CMAI), mood (Cornell Scale for Depression in Dementia, CSDD), anxiety (Rating Anxiety in Dementia, RAID), cognitive function (Severe Mini-Mental State Examination, SMMSE), and the overall severity of dementia (Bedford Alzheimer Nursing Severity Scale, BANS-S). They were assessed at baseline (pre-trial), in the middle (mid-trial), at the end of the intervention (post-trial), and 8 weeks after the intervention (follow-up). Patients in the MSSE group showed significant improvement in their RAID and BANS-S scores compared with the individualized music group post- versus pre-trial. With regard to agitation, there was improvement during the intervention in both the MSSE and individualized music groups in the CMAI total score after 16 weeks of intervention, with no significant differences between the groups. The results suggest that MSSE could have better effects on anxiety symptoms and dementia severity in comparison with individualized music sessions in elderly patients with severe dementia.

The Multisensory Environment (MSE) in Dementia Care: Examining Its Role and Quality From a User Perspective

Background:

Multisensory environments (MSEs) for people with dementia have been available over 20 years but are used in an ad hoc manner using an eclectic range of equipment. Care homes have endeavored to utilize this approach but have struggled to find a design and approach that works for this setting.

Aims:

Study aims were to appraise the evolving concept of MSEs from a user perspective, to study the aesthetic and functional qualities, to identify barriers to staff engagement with a sensory environment approach, and to identify design criteria to improve the potential of MSE for people with dementia.

Methods:

Data were collected from 16 care homes with experience of MSE using ethnographic methods, incorporating semi-structured interviews, and observations of MSE design. Analysis was undertaken using descriptive statistics and thematic analysis.

Results:

Observations revealed equipment that predominantly stimulated vision and touch. Thematic analysis of the semi-structured interviews revealed six themes: not knowing what to do in the room, good for people in the later stages of the disease, reduces anxiety, it’s a good activity, design and setting up of the space, and including relatives and care staff.

Conclusion:

Few MSEs in care homes are designed to meet needs of people with dementia, and staff receive little training in how to facilitate sessions. As such, MSEs are often underused despite perceived benefits. Results of this study have been used to identify the design principles that have been reviewed by relevant stakeholders.

The effectiveness of sensory stimulation therapy to strengthen the resilience of operating room nurses

BACKGROUND

Operating room (OR) nurses need to be resilient in order to cope with extreme demands in their workplace. This research focused on the effectiveness of sensory stimulation therapy (SST) to strengthen the resilience of nurses in the OR of a private hospital in the North West Province.

PURPOSE

The purpose was to determine the effectiveness of SST as an intervention to strengthen the resilience of OR nurses.

DESIGN

A quasi-experimental design was used.

METHOD

The population consisted of OR nurses and ICU nurses at private hospitals in the North West Province. All-inclusive sampling was used. Forty-one OR nurses formed the intervention group. A pilot group (8 subjects, OR nurses), as well as a comparison group (23 subjects, ICU nurses), was also sampled. An intervention, namely SST, was implemented with the intervention group. The resilience of the intervention group, pilot group and comparison group was measured before and after the implementation of the SST by means of Wagnild and Young's resilience questionnaire. The intervention group also completed a self-report questionnaire on their needs and suggestions for SST and wrote short narratives on their experience of SST. Data were analysed using descriptive and inferential statistics, and by thematic coding.

RESULTS

Results indicated a significant statistical increase in the intervention group's resilience levels. Results from the narratives confirmed that the intervention group's resilience may have been strengthened through SST.

CONCLUSION

SST has potential to strengthen the resilience of OR nurses.

Psychosocial interventions for people with dementia: An overview and commentary on recent developments

An influential review in 2010 concluded that non-pharmacological multi-component interventions have positive effects on cognitive functioning, activities of daily living, behaviour and mood of people with dementia. Our aim here is to provide an up-to-date overview of research into psychosocial interventions and their impact on psychosocial outcomes. We focused on randomised controlled trials, controlled studies and reviews published between October 2008 and August 2015, since the earlier review. The search of PsychInfo, Medline and the Cochrane database of systematic reviews yielded 61 relevant articles, organised into four themes echoing key phases of the care pathway: Living at home with dementia (five reviews, eight studies), carer interventions (three reviews, four studies), interventions in residential care (16 reviews, 12 studies) and end-of-life care (three reviews, two studies), along with an additional group spanning community and institutional settings (six reviews, two studies). Community findings suggested that appointment of dementia specialists and attention to case management can produce positive outcomes; physical therapies, cognitive training and modified cognitive behaviour therapy also had a range of benefits. There was more limited evidence of positive benefits for people with dementia through interventions with family carers. Thirty-two articles focused on the management of 'behavioural symptoms' through a range of interventions all of which had some evidence of benefit. Also a range of multi-component and specific interventions had benefits for cognitive, emotional and behavioural well-being of people with dementia in residential settings, as well as for quality of life. Overall, interventions tended to be short term with impact only measured in the short term. We recommend further research on interventions to promote living well in the community post-diagnosis and to address end-of-life care. Development of psychosocial interventions would benefit from moving beyond the focus on control of behaviours to focus on wider aspects of life for people with dementia.

Multisensory Stimulation as an Intervention Strategy for Elderly Patients With Severe Dementia: A Pilot Randomized Controlled Trial

The objective of this study was to compare the effect of multisensory stimulation environment (MSSE) and one-to-one activity sessions in the symptomatology of elderly individuals with severe dementia. Thirty-two participants were randomly assigned to the following 3 groups: MSSE, activity, and control group. The MSSE and activity groups participated in two 30-minute weekly sessions over 16 weeks. Pre-, mid-, and posttrial; 8-week follow-up behavior; mood; cognitive status; and dementia severity were registered. Patients in the MSSE group demonstrated a significant improvement in the Neuropsychiatric Inventory and Bedford Alzheimer Nursing Severity Scale scores compared with the activity group. Both MSSE and activity groups showed an improvement during the intervention in the Cohen-Mansfield Agitation Inventory aggressive behavior factor and total score, with no significant differences between groups. The MSSE may have better effects on neuropsychiatric symptoms and dementia severity in comparison with one-to-one activity sessions in patients with severe dementia.

Sensory stimulation for persons with dementia: a review of the literature

AIMS AND OBJECTIVES

To provide an overview of available sensory stimulation interventions, and their effect on persons with dementia and to present theoretical and methodological characteristics of the studies included.

BACKGROUND

Different sensory stimulation interventions are used for persons with dementia to increase alertness, reduce agitation and improve quality of life. However, the effect of these interventions is not clear, neither are their characteristics.

DESIGN

A systematic search and review of the literature with description of the content and an evaluation of theoretical and methodological approaches.

METHODS

Systematic searches in CINAHL, PubMed (Medline), The Cochrane library and PsycINFO. Studies included have been subject to quality assessment by means of Critical Appraisal Skills Programme.

RESULTS

Fifty-five studies were included and thirty of these documented significant effect. The effect of the sensory stimulation interventions mainly reported on negative behaviours, except from five studies assessing quality of life and well-being. The majority of the studies had methodological limitations. The different sensory stimulation interventions were organised into eight categories: music, light therapy, acupressure/reflexology, massage/aromatherapy and doll therapy/pet therapy/toy therapy, the Sonas programme and Snoezelen.

CONCLUSIONS

More studies are needed to clarify appropriate substantial background for the specific interventions. However, most of the studies based their interventions on a theoretical foundation. Furthermore, more research is needed to measure the effect of sensory stimulation on communication as well as quality of life. In addition, studies are to focus on whether the effect depends on the stage of dementia.

RELEVANCE TO CLINICAL PRACTICE

Nurses are to be aware of sensory stimulation as a possible intervention to improve persons' quality of life.

Optimal nonpharmacological management of agitation in Alzheimer's disease: challenges and solutions

Many patients with Alzheimer's disease will develop agitation at later stages of the disease, which constitutes one of the most challenging and distressing aspects of dementia. Recently, nonpharmacological therapies have become increasingly popular and have been proven to be effective in managing the behavioral symptoms (including agitation) that are common in the middle or later stages of dementia. These therapies seem to be a good alternative to pharmacological treatment to avoid unpleasant side effects. We present a systematic review of randomized controlled trials (RCTs) focused on the nonpharmacological management of agitation in Alzheimer's disease (AD) patients aged 65 years and above. Of the 754 studies found, eight met the inclusion criteria. This review suggests that music therapy is optimal for the management of agitation in institutionalized patients with moderately severe and severe AD, particularly when the intervention includes individualized and interactive music. Bright light therapy has little and possibly no clinically significant effects with respect to observational ratings of agitation but decreases caregiver ratings of physical and verbal agitation. Therapeutic touch is effective for reducing physical nonaggressive behaviors but is not superior to simulated therapeutic touch or usual care for reducing physically aggressive and verbally agitated behaviors. Melissa oil aromatherapy and behavioral management techniques are not superior to placebo or pharmacological therapies for managing agitation in AD. Further research in clinical trials is required to confirm the effectiveness and long-term effects of nonpharmacological interventions for managing agitation in AD. These types of studies may lead to the development of future intervention protocols to improve the well-being and daily functioning of these patients, thereby avoiding residential care placement.

Multisensory stimulation on mood, behavior, and biomedical parameters in people with dementia: is it more effective than conventional one-to-one stimulation?

The purpose of this study was to assess the effects of multisensory stimulation in a multisensory stimulation environment (MSSE) such as a Snoezelen room versus one-to-one activity sessions with regard to mood, behavior, and biomedical parameters (heart rate and blood oxygen saturation). The MSSE group and activity group (one-to-one activities) of patients with dementia participated in 2 weekly individualized intervention sessions over 16 weeks, where mood and behavior before, during, and after the sessions, and biomedical parameters immediately before and after, were recorded. Immediately after the sessions, patients spoke more spontaneously, related better to others, were more attentive to their environments, more active/alert, less bored/inactive, and more relaxed/content. Both groups exhibited decreases in heart rate and increases in oxygen saturation (Spo 2) values from before to after the sessions. The MSSE sessions in a Snoezelen room were found to be as effective as activity sessions, highlighting the importance of the one-to-one interaction with the therapist.

Effects of Multisensory Stimulation on a Sample of Institutionalized Elderly People With Dementia Diagnosis: A Controlled Longitudinal Trial

Long-term effects of multisensory stimulation were assessed using a "Snoezelen" room on older residents with dementia. Thirty patients were randomly assigned to 3 groups: multisensory stimulation environment (MSSE) group, individualized activities (activity) group, and control group. The MSSE and activity groups participated in two 30-minute weekly individualized intervention sessions over 16 weeks. Pre-, mid-, posttrial, and 8-week follow-up behavior, mood, cognitive, and functional impairment in basic activities of daily living were registered. Items included in the physically nonaggressive behavior factor improved significantly in post- versus pretrial in the MSSE group compared to the activity group, with no significant differences between MSSE and control groups. The MSSE and activity groups demonstrated behavior improvements and higher scores on the Cohen-Mansfield agitation inventory, verbal agitated behavior factor, and Neuropsychiatric Inventory-Nursing Home, with no significant differences between groups. The MSSE could have long-term positive effects on such neuropsychiatric symptoms in older people with dementia.

Making sense(s) in dementia: a multisensory and motor-based group activity program

Lack of engagement in meaningful activities is associated with poor quality of life in dementia; thus, the development of these activities has been recommended. This pilot study aimed to develop a multisensory and motor-based group activity program for residents with dementia and assess its impact on residents' behavior. The program was designed using a multisensory and motor-based approach in sixteen 45-minute weekly sessions tailored to residents' characteristics. Four residents with advanced dementia participated in the program. The frequency and duration of the residents' behavior were assessed using video recordings. All residents participated in the proposed activities, although they were more participative and communicative in some sessions than in others. Group activity programs based on multisensory and motor stimulation can be a promising approach for people with advanced dementia; however, further research is needed. This study may serve as reference to the implementation of future programs aiming to increase person-centeredness of the care provided.

Multisensory stimulation for people with dementia: a review of the literature

The use of multisensory stimulation in people with dementia is becoming increasingly popular in the last decades. The aim of this review is to analyze the therapeutic effectiveness of multisensory stimulation in people with dementia. We made a search on Medline and Web of Science databases referred to all researches published from the year 1990 to 2012, which used multisensory stimulation techniques in people with dementia. The revision of the 18 articles which fulfilled the inclusion/exclusion criteria seems to prove evidence that multisensory stimulation environments produce immediate positive effects on the behavior and mood of people with dementia. Based on the above, we think it can be a useful nonpharmacological intervention on neuropsychological symptoms though, in any case, it would be necessary to start more reliable protocols from the methodological point of view in order to establish its long-term effectiveness.

Motor and multisensory care-based approach in dementia: long-term effects of a pilot study

This study examined the short-, mid-, and long-term effects of a motor and multisensory care-based approach on (i) the behavior of institutionalized residents with dementia and (ii) care practices according to staff perspective. In all, 6 residents with moderate to severe dementia (mean age 80.83 ± 10.87 years) and 6 staff members (40 ± 10.87 years old) were recruited. Motor and multisensory stimulation strategies were implemented in residents' morning care. Data were collected with video recordings and focus-group interviews before, immediately after, at 3 months and 6 months after the intervention. The frequency and duration of each resident's behavior were analyzed. Content analysis was also performed. Results showed short-term improvements in residents' communication and engagement, followed by a sustained decline over time. Staff reported to change their practices; however, difficulties related to the institution organization were identified. There is a need to implement long-term strategies and involve institutions at different organizational levels to sustain the results.

Functional analytic multisensory environmental therapy for people with dementia

This paper introduces Functional Analytic Multisensory Environmental Therapy (FAMSET) for use with elders with dementia while using a multisensory environment/snoezelen room. The model introduces behavioral theory and practice to the multisensory environment treatment, addressing assessment, and, within session techniques, integrating behavioral interventions with emotion-oriented care. A modular approach is emphasized to delineate different treatment phases for multisensory environment therapy. The aim of the treatment is to provide a safe and effective framework for reducing the behavioral disturbance of the disease process, increasing elder well-being, and to promote transfer of positive effects to other environments outside of the multisensory treatment room.