Staedtler Amber V, Nunez Diane
Registered Nurse and DNP Student, Arizona State University, College of Nursing & Health Innovation, Phoenix, AZ, USA.
Worldviews Evid Based Nurs. 2015 Apr;12(2):108-15. doi: 10.1111/wvn.12086. Epub 2015 Mar 21.
Behavioral and psychiatric symptoms of dementia affect up to 90% of all patients at some point during their dementing illness. Today, many of these symptoms are treated with pharmacological therapy alone, incongruent with clinical recommendations. Barriers to the use of nonpharmacological interventions with dementia include a lack of education among caregivers on available options, shortage of time for implementation, lack of education on effects of nonpharmacological therapy, poor staff to resident ratios, and unmodifiable physical environments.
The purpose of this paper is to explore current literature regarding the implementation of nonpharmacological therapy as an adjunct treatment to manage agitation in dementia, to identify practice discrepancies seen commonly among formal and informal caregivers, and to make recommendations for implementing evidence into practice.
A systematic review of the literature published between 2009 and 2014 was conducted. Four databases were searched including CINAHL, Pubmed, the Cochrane Library, and PsycInfo.
The most prevalent and substantial conclusion among the 10 studies evaluated is that nonpharmacological therapy is safe and effective. Although not every study was able to show statistically significant outcomes when compared to controls, all studies demonstrated a positive trend toward decreasing agitation without any adverse side effects.
A multicomponent caregiver education program focused on evidence-based nonpharmacological strategies for addressing agitation in persons with Alzheimer's disease has the potential to decrease agitation, improve patient outcomes, and increase caregiver satisfaction.
痴呆症的行为和精神症状在所有痴呆症患者病程中的某个阶段影响高达90%的患者。如今，许多此类症状仅通过药物治疗，这与临床建议不符。痴呆症患者使用非药物干预措施的障碍包括护理人员对可用选项缺乏了解、实施时间不足、对非药物治疗效果缺乏认识、工作人员与患者比例不佳以及不可改变的物理环境。
本文旨在探讨有关实施非药物治疗作为辅助治疗来管理痴呆症患者激越行为的现有文献，识别正规和非正规护理人员中常见的实践差异，并为将证据应用于实践提出建议。
对2009年至2014年发表的文献进行系统综述。检索了四个数据库，包括护理学与健康领域数据库（CINAHL）、医学期刊数据库（Pubmed）、考克兰图书馆和心理学文摘数据库（PsycInfo）。
在评估的10项研究中，最普遍和重要的结论是非药物治疗是安全有效的。虽然与对照组相比，并非每项研究都能显示出具有统计学意义的结果，但所有研究都表明在减少激越行为方面有积极趋势，且无任何不良副作用。
一个针对照顾者的多成分教育项目，重点是基于证据的非药物策略以解决阿尔茨海默病患者的激越行为，有可能减少激越行为、改善患者结局并提高照顾者满意度。
