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Abstract
Objectives This review aims to understand what elements of psychosocial interventions are associated with improved outcomes for people with dementia to inform implementation in care homes.
Design A systematic review of qualitative and quantitative intervention studies was undertaken.
Eligibility criteria for included studies We included primary research studies evaluating psychosocial interventions that trained care home staff to deliver a specific intervention or that sought to change how staff delivered care to residents with dementia and reported staff and resident qualitative or quantitative outcomes.
Methods We searched MEDLINE, PsychINFO and EMBASE electronic databases and hand-searched references up to May 2016. Quality of included papers was rated independently by 2 authors, using operationalised checklists derived from standard criteria. We discussed discrepancies and reached consensus. We conducted a narrative synthesis of quantitative and a thematic synthesis of qualitative findings to find what was effective immediately and in sustaining change.
Results We identified 49 papers fulfilling predetermined criteria. We found a lack of higher quality quantitative evidence that effects could be sustained after psychosocial interventions finished with no evidence that interventions continued to work after 6 months. Qualitative findings suggest that staff valued interventions focusing on getting to know, understand and connect with residents with dementia. Successful elements of interventions included interactive training, post-training support, aiming to train most staff, retaining written materials afterwards and building interventions into routine care.
Conclusions Psychosocial interventions can improve outcomes for staff and residents with dementia in care homes; however, many trial results are limited. Synthesis of qualitative findings highlight core components of interventions that staff value and feel improve care. These findings provide useful evidence to inform the development of sustainable, effective psychosocial interventions in care homes.
Trial registration number CRD42015017621.
- QUALITATIVE RESEARCH
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Footnotes
Contributors All authors made a substantial contribution to this work. PR, GL, JM and CC all contributed to the conception and design of the review and PR drafted the paper. All authors critically revised it and gave final approval for this version to be published. PR read and screened titles and abstracts of studies and PR and CC independently read all retained papers. PR, CC and AM rated the quality of the quantitative papers and PR and CC rated the quality of the qualitative papers.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. PR's salary is part funded from the Economic and Social Research Council (ESRC) and National Institute for Health Research (NIHR) funded programme grant MARQUE: Managing agitation and raising quality of life for people with moderate/severe dementia (ES/L001780/1).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Details of excluded papers and the qualitative data synthesis are available from the first author on request.