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Geriatric medicine
Original research
Occupational therapy for people with dementia and their family carers provided at home: a systematic review and meta-analysis
  1. Sally Bennett1,
  2. Kate Laver2,
  3. Sebastian Voigt-Radloff3,
  4. Lori Letts4,
  5. Lindy Clemson5,
  6. Maud Graff6,
  7. Jodie Wiseman7,
  8. Laura Gitlin8
  1. 1 School of Health and Rehabilitation Sciences, The University Queensland, Brisbane, Queensland, Australia
  2. 2 Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
  3. 3 Institute for Evidence in Medicine (for Cochrane Germany Foundation), Center for Geriatric Medicine and Gerontology, University of Freiburg, Germany
  4. 4 School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
  5. 5 Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
  6. 6 IQ Healthcare & Radboud Alzheimer Centre, Radboud University, Nijmegen, The Netherlands
  7. 7 Centre for Children’s Health Research, The University of Queensland, Brisbane, Queensland, Australia
  8. 8 College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
  1. Correspondence to Associate Professor Sally Bennett; sally.bennett{at}uq.edu.au

Abstract

Objective To determine the effect of occupational therapy provided at home on activities of daily living, behavioural and psychological symptoms of dementia (BPSD) and quality of life (QOL) for people with dementia, and the effect on family carer burden, depression and QOL.

Design Systematic review and meta-analysis.

Methods Eight databases were searched to February 2018. Randomised controlled trials of occupational therapy delivered at home for people with dementia and their family carers that measured ADL, and/or BPSD were included. Two independent reviewers determined eligibility, risk of bias and extracted data.

Results Fifteen trials were included (n=2063). Occupational therapy comprised multiple components (median=8 sessions). Compared with usual care or attention control occupational therapy resulted in improvements in the following outcomes for people with dementia: overall ADL after intervention (standardised means difference (SMD) 0.61, 95% CI 0.16 to 1.05); instrumental ADL alone (SMD 0.22, 95% CI 0.07 to 0.37; moderate quality); number of behavioural and psychological symptoms (SMD −0.32, 95% CI −0.57 to −0.08; moderate quality); and QOL (SMD 0.76, 95% CI 0.28 to 1.24) after the intervention and at follow-up (SMD 1.07, 95% CI 0.58 to 1.55). Carers reported less hours assisting the person with dementia (SMD −0.33, 95% CI −0.58 to −0.07); had less distress with behaviours (SMD −0.23, 95% CI −0.42 to −0.05; moderate quality) and improved QOL (SMD 0.99, 95% CI 0.66 to 1.33; moderate quality). Two studies compared occupational therapy with a comparison intervention and found no statistically significant results. GRADE ratings indicated evidence was very low to moderate quality.

Conclusions Findings suggest that occupational therapy provided at home may improve a range of important outcomes for people with dementia and their family carers. Health professionals could consider referring them for occupational therapy.

PROSPERO registration number CRD42011001166.

  • dementia
  • geriatric medicine
  • occupational therapy
  • systematic review

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/bmjopen-2018-026308

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    Footnotes

    • Contributors Conceptualisation: SB, SV-R, MG and LL. Methodology: SB, SV-R, MG and LL. Investigation: SB, JW, KL, LL (study selection), SB, KL, JW, LL (data extraction and risk of bias assessments). Formal analysis: SB (analyses), SB, LC and KL (final analyses decisions). Verification: SB, KL, SV-R, JW, LC, LL and LG. Writing: SB, JW and KL. Review and editing: SB, KL, SV-R, JW, LC, LL and LG. Project administration: SB.

    • Funding The first author’s contribution was partially supported by The University of Queensland, Australia. Grant number: 2007000387.

    • Competing interests Four authors (MG, SV-R, LC and LG) are authors of trials included in this systematic review. They were therefore not included in study selection, assessment of risk of bias or analysis. LG reports funding grants from National Institute on Aging, other from Johns Hopkins, during the conduct of the study.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.