Travers Catherine, Brooks Deborah, Hines Sonia, O'Reilly Maria, McMaster Mitchell, He Wei, MacAndrew Margaret, Fielding Elaine, Karlsson Lina, Beattie Elizabeth
1Dementia Collaborative Research Centre: Carers and Consumers (DCRC: CC), School of Nursing, Queensland University of Technology, Brisbane, Australia 2Nursing Research Centre and The Queensland Centre for Evidence Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence, Mater Health Services, South Brisbane, Australia 3Division of Occupational Therapy, School of Human, Health and Social Sciences, CQ University Bundaberg, Bundaberg, Australia 4Centre for Research on Ageing, Health and Wellbeing (CRAHW), Australian National University, Canberra, Australia 5School of Nursing, Queensland University of Technology, Brisbane, Australia.
JBI Database System Rev Implement Rep. 2016 Dec;14(12):163-225. doi: 10.11124/JBISRIR-2016-003230.
The ability to participate in valued activities, whether for work, leisure or family, is an important aspect of personal identity. In dementia, progressive memory loss means that abilities developed over a lifetime begin to be lost as well, contributing to the loss of self and identity. Some studies have reported that activities or interventions tailored to be meaningful to the person with dementia (defined as any activity important to the individual) are more effective in addressing behavioral and psychological symptoms of dementia (BPSD) and improving quality of life (QoL) than those that are not so tailored. However, the effectiveness of individualizing interventions or activities for this population is not known.
In response to consumer feedback by the Consumer Dementia Research Network that this question ought to be addressed, this review was undertaken, the aim of which was to determine the effectiveness of meaningful occupation interventions for people living with dementia in residential aged care facilities (RACFs).
People living with dementia in RACFs (nursing homes).Any intervention that was individualized to be meaningful to the participant, versus any active control condition or usual care.Experimental and observational studies.
Quality of life, BPSD (such as agitation, aggression, depression, wandering and apathy), mood, function, cognition and sleep.
The search strategy aimed to identify both published and unpublished studies, with the following 12 databases extensively searched: PubMed, CINAHL, PsycINFO, ISI Web of Science, OTSeeker, Embase, Cochrane CENTRAL, clinicaltrials.gov, Mednar, OpenSIGLE, New York Academy of Medicine Library Gray Literature Report, ProQuest Dissertations and Theses. The search strategy was limited to papers published in English between 2004 and January 31, 2015.
All studies were assessed independently by two reviewers for relevance, eligibility and methodological quality.
Data from included papers were extracted using a standard data extraction tool.
Where possible, study results were pooled in statistical meta-analysis. Alternatively, results are presented in narrative and tabular form.
A total of 5274 citations were identified; after removal of duplicates, assessment for relevance and eligibility, 61 studies underwent critical appraisal. Thirty-four studies met the quality criteria and were included in a quantitative synthesis. A wide range of interventions were evaluated including individualized recreational activities (13 studies), reminiscence therapy (RT) (seven studies), music therapy interventions (six studies), training staff to develop individual care plans using person-centered care (PCC) or similar approaches (three studies), animal-assisted therapy (two studies), multi-sensory interventions (MSIs) (two studies) and social interaction (one study), all of which measured a number of different outcomes. Overall, and in spite of most studies being small-scale and of relatively brief duration, all interventions with the exception of Snoezelen therapy (a MSI) reported some benefits for people with dementia living in RACFs. The most frequently reported benefits were reductions in agitation (the most frequently assessed outcome), passivity and depression, improved QoL and increases in pleasure and interest. However, the majority of studies generally implemented the intervention, whether it was individualized activities, music or RT or other, in conjunction with one-to-one social interaction, and the relative importance of the intervention in comparison to one-to-one social contact for effectiveness cannot be determined from this review.
Providing meaningful or individualized tailored activities for people with dementia living in RACFs appears to be effective for a range of behavioral and psychological symptoms. The strongest evidence was for individualized activities/recreational interventions for a range of BPSD; preferred music for agitation, depression and anxiety; and RT for mood and cognitive functioning. Insufficient evidence precluded making recommendations regarding animal-assisted (dog) therapy and training staff to develop individual care plans using PCC or similar approaches, while there was no good quality evidence to show that Snoezelen was effective for any outcome. What remains unclear, however, is whether any of these interventions is more effective than the provision of one-to-one social interaction.
参与有价值活动的能力，无论是工作、休闲还是家庭活动，都是个人身份认同的重要方面。在痴呆症患者中，渐进性的记忆丧失意味着一生所培养的能力也开始丧失，这导致自我和身份认同的丧失。一些研究报告称，针对痴呆症患者量身定制的有意义活动或干预措施（定义为对个人重要的任何活动），在解决痴呆症的行为和心理症状（BPSD）以及提高生活质量（QoL）方面，比未量身定制的措施更有效。然而，针对这一人群进行个性化干预或活动的效果尚不清楚。
应痴呆症消费者研究网络的消费者反馈，即这个问题应该得到解决，进行了本综述，其目的是确定在老年护理机构（RACFs）中，有意义的职业干预对痴呆症患者的有效性。
RACFs（养老院）中的痴呆症患者。任何针对参与者量身定制的、有意义的干预措施，与任何积极对照条件或常规护理相对比。实验性和观察性研究。
生活质量、BPSD（如躁动、攻击行为、抑郁、徘徊和冷漠）、情绪、功能、认知和睡眠。
检索策略旨在识别已发表和未发表的研究，广泛检索了以下12个数据库：PubMed、CINAHL、PsycINFO、ISI Web of Science、OTSeeker、Embase、Cochrane CENTRAL、clinicaltrials.gov、Mednar、OpenSIGLE、纽约医学院图书馆灰色文献报告、ProQuest学位论文数据库。检索策略仅限于2004年至2015年1月31日期间发表的英文论文。
所有研究均由两名评审员独立评估其相关性、合格性和方法学质量。
使用标准数据提取工具从纳入论文中提取数据。
在可能的情况下，将研究结果汇总进行统计荟萃分析。或者，结果以叙述性和表格形式呈现。
共识别出5274条引文；在去除重复项、评估相关性和合格性后，对61项研究进行了批判性评价。34项研究符合质量标准并纳入定量综合分析。评估了广泛的干预措施，包括个性化娱乐活动（13项研究）、回忆疗法（RT）（7项研究）、音乐疗法干预（6项研究）、培训工作人员使用以人为本的护理（PCC）或类似方法制定个性化护理计划（3项研究）、动物辅助疗法（2项研究）、多感官干预（MSIs）（2项研究）和社交互动（1项研究），所有这些都测量了许多不同的结果。总体而言，尽管大多数研究规模较小且持续时间相对较短，但除了Snoezelen疗法（一种MSI）外，所有干预措施都报告了对RACFs中痴呆症患者有一些益处。最常报告的益处包括躁动（最常评估的结果）、被动性和抑郁的减少，生活质量的改善以及愉悦感和兴趣的增加。然而，大多数研究通常将干预措施（无论是个性化活动、音乐或RT或其他）与一对一的社交互动结合实施，从本综述中无法确定干预措施与一对一社交接触相比对有效性的相对重要性。
为居住在RACFs中的痴呆症患者提供有意义或个性化定制的活动，对于一系列行为和心理症状似乎是有效的。最有力的证据是针对一系列BPSD的个性化活动/娱乐干预；针对躁动、抑郁和焦虑选择的音乐；以及针对情绪和认知功能的RT。证据不足，无法就动物辅助（狗）疗法以及培训工作人员使用PCC或类似方法制定个性化护理计划提出建议，同时没有高质量证据表明Snoezelen对任何结果有效。然而，尚不清楚这些干预措施中的任何一种是否比提供一对一的社交互动更有效。
