Stimulation-Oriented Interventions for Behavioral Problems among People with Dementia: A Systematic Review and Meta-Analysis

Eun Young Kim; Sung-Dong Hwang; Eun Joo Kim

doi:10.4040/jkan.2016.46.4.475

Journal List > J Korean Acad Nurs > v.46(4) > 1003175

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Kim, Hwang, and Kim: Stimulation-Oriented Interventions for Behavioral Problems among People with Dementia: A Systematic Review and Meta-Analysis

Review Article

J Korean Acad Nurs 2016;46(4):475-489.

Published online: 15 August 2016

DOI: https://doi.org/10.4040/jkan.2016.46.4.475

Stimulation-Oriented Interventions for Behavioral Problems among People with Dementia: A Systematic Review and Meta-Analysis

Eun Young Kim¹, Sung-Dong Hwang², Eun Joo Kim^3,

¹Department of Psychotherapy, College of Nursing and Public Health, Kyungil University, Kyungsan

²Department of Social Welfare, College of Social Science, Kyungpook National University, Daegu

³Department of Nursing, College of Health and Medical Science, Daejeon University, Korea

Address reprint requests to : Kim, Eun Joo Department of Nursing, College of Health and Medical Science, Daejeon University, 62 Daehakro, Dong-gu, Daejoen 34519, Korea Tel: +82-42-280-2656 Fax: +82-42-280-2785 E-mail: ejkim@dju.kr

Received 31 August 2015 Revised 15 November 2015 Accepted 17 December 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study was a systematic review and meta-analysis designed to investigate the effects of stimulation-oriented interventions for behavioral problems among people with dementia.

Methods

Based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), a literature search was conducted using seven electronic databases, gray literature, and other sources. Methodological quality was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) for randomized controlled trials (RCTs). Data were analyzed using R with the ‘meta’ package and the Comprehensive Meta-Analysis (CMA 2.0) program.

Results

Sixteen studies were included for meta-analysis to investigate the effect of stimulation-oriented interventions. The quality of individual studies was rated as ‘++’ for eight studies and ‘+’ for the rest. The effect sizes were analyzed according to three subgroups of interventions (light, music, and others); Hedges’ g=0.04 (95% CI: -0.38~0.46), -0.23 (95% CI: -0.56~0.10), -0.34 (95% CI: -0.34~0.00), respectively. To explore the possible causes of heterogeneity (I²=62.8%), meta-regression was conducted with covariates of sample size, number of sessions, and length of session (time). No moderating effects were found for sample size or number of sessions, but session time showed a significant effect (Z=1.96, 95% CI: 0.00~0.01). Finally, a funnel plot along with Egger's regression test was performed to check for publication bias, but no significant bias was detected.

Conclusion

Based on these findings, stimulation-oriented interventions seem to have a small effect for behavioral problems among people with dementia. Further research is needed to identify optimum time of the interventions for behavioral problems among dementia patients.

Keywords: Dementia, Behavioral symptoms, Sensory art therapies, Acoustic stimulation, Meta-analysis

References

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Figure 1.

Flow diagram of study selection.

Figure 2.

Forest plots of the effects of stimulation–oriented interventions.

Figure 3.

Regression plot of session time on treatment effect.

Figure 4.

Funnel plot of standard error by Hedges’ g.

Table 1.

Descriptive Summary of Included Studies

No	Author (year)	Country	Subjects			Setting	Severity/ stage of dementia	Interventions					Outcome measurements	Quality assessment	RCT type
			Age (year) (M±SD)	Sample size (n)				Exp. Type	Cont. type	Length (min.)	Sessions	duration (wks.)
				Exp.	Cont.
1	Ancoli–Israel et al. (2003)	USA	82.30 ± 7.60	30	31	Nursing home	Mild to severe	Bright light	Red dim light	120	10	1.43	CMAI, ABRS	+	Parallel –group
2	Baker et al. (2001)	UK	78.00	23	25	Hospital	Moderate to severe	Multisensory stimulation	Activity	30	8	4	REHAB scale, BMD, BRS	++	Parallel –group
3	Ballard et al. (2002)	UK	78.50±8.10	35	36	Nursing home	Severe	Aroma	Placebo	2	56	4	CMAI, NPI	++	Parallel –group
4	Burns et al. (2009)	UK	Exp:84.50±1.70 Cont:82.50±1.50	22	26	Nursing home	Mild to severe	Bright light	Usual light	120	14	2	CMAI	++	Parallel –group
5	Camberg et al. (1999)	USA	82.70±7.50	49	49	Nursing home	Severe	Simulated presence	Placebo	30	34	5	SCAMI, SOAPD	++	Factorial
6	Cooke et al. (2010)	Australia	≥65.00	24	23	Care facility	Mild to moderate	Music	Reading	40	24	8	CAMI–SF	++	Crossover
7	Eggermont et al. (2010)	Netherl –ands	84.30	41	38	Nursing home	Mild to moderate	Walking	No intervention	30	30	6	Actiwatch (e.g., Night–time restlessness)	+	Parallel –group
8	Lin et al. (2011)	Taiwan	Exp: 81.46±7.34 Cont: 82.15±6.28	49	51	Nursing facility	Mild to severe	Music	Daily activity	30	12	6	C–CMAI	+	Parallel –group
9	Narme et al. (2014)	France	Exp: 86.70±6.40 Cont: 87.50±6.00	18	19	Hospital	Moderate to severe	Music	Cooking	60	8	4	CMAI, NPI	+	Parallel –group
10	Raglio et al. (2010)	Italy	Exp: 85.40±6.50 Cont: 84.60±6.80	27	26	Nursing home	Moderate to severe	Music	Standard care	30	36	6	NPI	+	Parallel –group
11	Remington (2002)	USA	82.40	17	17	Nursing home	Mild to severe	Music	No intervention	10	1	NR	Modified–CMAI	+	Factorial
12	Ridder et al. (2013)	Denmark, Norway	Exp:82.17±8.84 Cont:80.20±8.67	21	21	Nursing home	Moderate to severe	Music	Standard care	30	12	6	CMAI–fr, CMAI–di	++	Crossover
13	Robichaud et al. (1994)	Canada	Exp:76.60±5.80 Cont:80.10±7.90	22	18	Institution (hospital, nursing home)	Mild to severe	Sensory integration U	Usual daily activity	45	30	10	RMBPC	+	Parallel –group
14	Sung et al. (2006)	Taiwan	77.61±8.43	18	18	Care facility	Moderate to severe	Music	Usual care	30	8	4	Modified–CMAI	++	Parallel –group
15	Sung et al. (2012)	Taiwan	Exp:81.37±9.14 Cont:79.50±8.76	27	28	Care facility	Mild to moderate	Music	Usual care	30	12	6	CMAI	+	Parallel –group
16	Vink et al. (2013)	Nether –lands	82.16±6.87	43	34	Nursing home	Mild to severe	Music	General activity	40	32	16	CMAI	++	Parallel –group
Total				466	460					677	327	88.43

Exp.=Experimental group; Cont.=Control Group; CMAI=The Cohen–Mansfield Agitation Inventory; C–CMAI=Chinese version of the Cohen–Mansfield Agitation Inventory; min=minutes; NPI=Neuropsychiatric Inventory; NR=Not Reported, ABRS=Agitated Behavior Rating Scale; RMBPC=Revised Memory and Behaviors Problems Checklist; SOAPD=The scale for the Observation of Agitation in Persons with Dementia; BMD=The Behavior and Mood Disturbance Scale; BRS=The Behavioral Rating Scale; REHAB=Rehabilitation Evaluation Hall and Baker; CMAI–fr=CMAI frequency; CMAI–di=CMAI disruptiveness.

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