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Evidence Summary
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In people with dementia, massage therapy and pet therapy reduce agitation compared with usual care or placebo
Leng M, Zhao Y, Wang Z Comparative efficacy of non-pharmacological interventions on agitation in people with dementia: A systematic review and Bayesian network meta-analysis. Int J Nurs Stud. 2020 Feb;102:103489.
Review questions
In people with dementia, do nondrug interventions reduce agitation? Are some nondrug interventions better than others?
Background
Agitation is common in people with dementia. Signs of agitation include pacing, restlessness, irritability, and sometimes physical or verbal outbursts. Agitation can be distressing for people with dementia and their caregivers.
Interventions that prevent or decrease agitation may reduce distress. This review looks at how different nondrug interventions compare with one another for managing agitation in people with dementia.
How the review was done
The researchers did a systematic review of studies available up to January 2019. They found 65 randomized controlled trials.
The key features of the studies were:
- all people had dementia;
- most people were 60 years of age or older;
- nondrug interventions were compared with a control intervention (mostly usual care or placebo);
- nondrug interventions included music therapy, personally tailored interventions (i.e., interventions based on a person’s abilities and interests), massage therapy (typically hand or foot massage), aromatherapy, physical exercise interventions, reminiscence therapy, light therapy, animal-assisted interventions (e.g., participating in dog-related activities like petting, brushing, and feeding), pet robot interventions, dementia-care mapping, and horticultural therapy; and
- people were treated for 5 days to 15 months.
What the researchers found
Compared with control interventions (also see Table below):
- massage therapy reduced agitation by a moderate amount;
- personally tailored interventions, animal-assisted interventions, and pet robot interventions reduced agitation by a small amount; and
- other nondrug interventions did not reduce agitation.
In an analysis that lets you compare interventions that were not directly compared with one another in the individual studies:
· massage therapy reduced agitation compared with light therapy, music therapy, or reminiscence therapy; and
· other nondrug interventions did not differ from one another.
Conclusion
In people with dementia, massage therapy, animal-assisted interventions, personally-tailored interventions, and pet robot interventions reduce agitation by a small-to-moderate amount.
Nondrug interventions vs control* for reducing agitation in people with dementia
Music therapy | 16 trials (16 to 100 people) | No effect |
Personally tailored interventions | 14 trials (21 to 349 people) | Small reduction in agitation |
Massage therapy | 8 trials (35 to 56 people) | Moderate reduction in agitation |
Aromatherapy | 6 trials (28 to 72 people) | No effect |
Physical exercise interventions | 5 trials (27 to 116 people) | No effect |
Reminiscence therapy | 4 trials (24 to 304 people) | No effect |
Light therapy | 4 trials (48 to 94 people) | No effect |
Animal-assisted interventions | 4 trials (40 to 88 people) | Small reduction in agitation |
Pet robot interventions | 3 trials (24 to 275 people) | Small reduction in agitation |
Dementia-care mapping | 3 trials (192 to 435 people) | No effect |
Horticultural therapy | 2 trials (13 to 20 people) | No effect |
Glossary
Placebo
A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.
Related Evidence Summaries
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Cochrane Database of Systematic Reviews (2019)
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American Journal of Alzheimers Diseases and Other Dementias (2018)
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Cochrane Database of Systematic Reviews (2014)
Related Web Resources
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Informed Health Online
Gingko supplements (240 mg per day) may help reduce symptoms of Alzheimer's disease and enable you to perform daily tasks better. Be aware that gingko could interact with other medications, so talk to your doctor before taking any supplements.
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HealthLine
Dementia affects millions of people around the world, and there is no current treatment. There are a few ways to lower your risk. Eat a well-balanced diet, exercise, stay social, and limit alcohol and smoking.
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Canadian Institute for Health Information
Older adults with dementia may need to move into long-term care homes if they can no longer stay at home. These people have higher risk of getting physically restrained or given antipsychotic medication. Changes to policy and education have made these things happen less often.
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal
(
info@mcmasteroptimalaging.org).