Tan Davynn Gim Hoon, Boo Belinda Melody Bernadette, Chong Cheyenne Shuen, Tan Megan Michelle Ling-Li, Wong Boon-Seng
Health and Social Sciences, Singapore Institute of Technology, Singapore, Singapore.
Department of Physiology, National University of Singapore, Singapore, Singapore.
Front Aging Neurosci. 2022 Aug 11;14:846271. doi: 10.3389/fnagi.2022.846271. eCollection 2022.
Dementia is a neurodegenerative condition characterized by cognitive decline and increased functional dependency. With most persons living with dementia (PLWDs) residing at home, home-based interventions provide a convenient and individualized alternative for person-centered care. Most of the evidence focused on specific interventions or exercise-based activities; there remains a gap in understanding the impacts of a broader range of non-exercise interventions on PLWDs and their caregivers. This review aimed to understand the impacts of home-based, non-exercise interventions on the behavioral, functional, cognitive, and mood outcomes of PLWDs, and their caregiver's quality of life (QoL), burden and mood.
Search for studies published up to June 2020 was conducted on CINAHL, PsycArticles, PubMed, SAGE Journals, Science Direct, and Web of Science. A search was also done manually based on the bibliographies of selected articles. The inclusion criteria for the systematic review were: (i) participants with a medical diagnosis of dementia, (ii) participants who resided at own home, (iii) intervention in the home setting, (iv) investigate interventions other than physical exercise, (v) randomized controlled trials (RCTs) or quasi-experimental studies, and (vi) full-text study published in English and in a peer-reviewed journal.
Eighteen studies consisting of 14 RCTs and 4 quasi-experimental studies were included. Interventions included were occupational therapy, cognitive rehabilitation, tailored activity program, cognitive stimulation therapy, personalized reminiscence, music therapy, reality orientation, biobehavioral and multicomponent interventions. Results were mixed, but important intervention features were highlighted. Personalized activities for PLWDs that are aligned to their interest and ability appeared to contribute to intervention effectiveness especially in reducing behavioral symptoms and improving functional status. Involvement of caregivers in interventions is another feature of effective interventions for both the PLWDs and the caregivers' QoL, provided it is not deemed demanding or challenging to the caregivers. The inclusion of caregiver's education was effective in reducing caregivers' burden, particularly when the interventions improved the PLWD's functional status.
痴呆症是一种神经退行性疾病，其特征为认知能力下降和功能依赖性增加。由于大多数痴呆症患者居家生活，居家干预为以患者为中心的护理提供了一种便捷且个性化的选择。大多数证据聚焦于特定干预措施或基于锻炼的活动；对于更广泛的非锻炼干预措施对痴呆症患者及其照护者的影响，我们仍缺乏了解。本综述旨在了解居家非锻炼干预措施对痴呆症患者的行为、功能、认知和情绪结局，以及对其照护者生活质量（QoL）、负担和情绪的影响。
在护理及健康领域数据库（CINAHL）、心理学文摘数据库（PsycArticles）、医学期刊数据库（PubMed）、SAGE期刊数据库、科学Direct数据库和科学引文索引数据库（Web of Science）中检索截至2020年6月发表的研究。还根据所选文章的参考文献进行了手动检索。系统综述的纳入标准为：（i）医学诊断为痴呆症的参与者；（ii）居家生活的参与者；（iii）在家庭环境中的干预；（iv）调查除体育锻炼之外的干预措施；（v）随机对照试验（RCT）或准实验研究；（vi）以英文发表且在同行评审期刊上的全文研究。
纳入了18项研究，其中包括14项随机对照试验和4项准实验研究。纳入的干预措施包括职业治疗、认知康复、定制活动计划、认知刺激疗法、个性化回忆疗法、音乐疗法、现实定向疗法、生物行为和多成分干预。结果不一，但突出了重要的干预特征。针对痴呆症患者的与其兴趣和能力相匹配的个性化活动似乎有助于提高干预效果，尤其是在减少行为症状和改善功能状态方面。照护者参与干预是对痴呆症患者及其照护者生活质量有效的干预措施的另一个特征，前提是这对照护者来说不被认为要求过高或具有挑战性。纳入照护者教育在减轻照护者负担方面是有效的，特别是当干预措施改善了痴呆症患者的功能状态时。
