Centre for Economic and Social Research on Dementia (FK), National University of Ireland Galway, Galway, Ireland.
Centre for Applied Dementia Studies (GM, KL), University of Bradford, Bradford, England.
Am J Geriatr Psychiatry. 2019 Jun;27(6):641-651. doi: 10.1016/j.jagp.2018.12.027. Epub 2018 Dec 24.
National policies and evidence reviews recommend psychosocial interventions (PIs) as an essential support, particularly in the period following dementia diagnosis. However, availability and uptake of these interventions are comparatively low. One of the reasons for this is that clinicians lack information about what might be provided and the potential benefits of different interventions. This article identifies and describes PIs for community-dwelling people following diagnosis of mild to moderate dementia and presents the available evidence to inform practice decisions. A systematic scoping review was employed to map the evidence relating to PIs for this group. This identified 63 relevant studies, testing 69 interventions, which could be grouped into 6 intervention categories: 20 cognition-oriented, 11 behavior-oriented, 11 stimulation-oriented, 13 emotion-oriented, 5 social-oriented, and 9 multimodal. There were three targets for outcome measurement of these PIs: the person with dementia, the family caregiver, and the person-caregiver dyad. Over 154 outcome measures were identified in the studies, with outcomes measured across 11 main domains. The lack of a classification framework for PIs means it is difficult to create a meaningful synthesis of the breadth of relevant evidence to guide clinical practice. Possible dimensions of a classification framework are proposed to begin to address this gap.
国家政策和证据审查建议将心理社会干预(PIs)作为必要的支持,特别是在痴呆症诊断后。然而,这些干预措施的可及性和利用率相对较低。其中一个原因是临床医生缺乏关于可能提供哪些干预措施以及不同干预措施的潜在益处的信息。本文确定并描述了针对轻度至中度痴呆症社区居住者的 PIs,并提供了可用的证据来为实践决策提供信息。采用系统范围的审查来绘制与该人群相关的 PIs 的证据。这确定了 63 项相关研究,测试了 69 项干预措施,可以分为 6 个干预类别:20 个认知导向,11 个行为导向,11 个刺激导向,13 个情感导向,5 个社会导向和 9 个多模式。这些 PIs 的三个目标是测量结果:痴呆症患者、家庭照顾者和患者-照顾者二人组。研究中确定了超过 154 个的评估指标,涉及 11 个主要领域。缺乏针对 PIs 的分类框架意味着难以对相关证据的广度进行有意义的综合,以指导临床实践。提出了分类框架的可能维度,以开始解决这一差距。