Hwang Jasmine Jihye, Donnelly Tam Truong, Raffin Bouchal Shelley, Davidson Sandra
Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
J Psychiatr Ment Health Nurs. 2023 Dec;30(6):1054-1081. doi: 10.1111/jpm.12932. Epub 2023 May 19.
Research has shown effectiveness of nonpharmacological interventions in improving or maintaining cognition, mood, functioning, self-efficacy and quality of life for persons with mild-to-moderate dementia (PWDs). These interventions are critical during the earlier stages of dementia. However, Canadian and international literature report underutilization of and difficulty accessing the interventions.
To our knowledge, this is the first review that explored factors influencing seniors' utilization of nonpharmacological interventions in the earlier stages of dementia. This review contributed to the discovery of unique factors such as PWDs' beliefs, fears, perceptions, and acceptability of nonpharmacological interventions and environmental influences on intervention provision. PWDs' intervention uptake may appear as a matter of personal choices related to individuals' knowledge, beliefs and perceptions. However, the analysis of the research evidence suggests that PWDs' choices are shaped by environmental factors such as formal and informal caregiver support, acceptability and accessibility of nonpharmacological interventions, dementia care workforce, community's attitudes towards dementia and funding. The complex interplay among factors highlights the importance of targeting health promotion strategies at both individuals and their environments.
The review findings feature opportunities for healthcare practitioners, including mental health nurses, in advocating for PWDs' evidence-informed decision-making and access to desired nonpharmacological treatments. Involvement of patients and families in care-planning through ongoing assessment of health and learning needs, as well as enablers and barriers to using interventions, continuing information provision, and personalized referrals to appropriate services can promote PWDs' rights to healthcare.
INTRODUCTION: Despite the significance of nonpharmacological interventions in optimal management of mild-to-moderate dementia, it remains unclear in the literature how persons with mild-to-moderate dementia (PWDs) view, understand and access nonpharmacological interventions.
The purpose of this review was to explore the extent and nature of evidence concerning factors that influence the use of nonpharmacological interventions for community-dwelling seniors with mild-to-moderate dementia.
An integrative review was undertaken following Toronto and Remington (A step-by-step guide to conducting an integrative review, 2020)'s instruction which expanded Torraco (Human Resource Development Review, 2016, 15, 404)'s and Whittemore and Knafl (Journal of Advanced Nursing, 2005, 52, 546)'s guidance.
The review of 16 studies suggests that PWDs' use of nonpharmacological interventions is shaped by a complex interplay of various personal, interpersonal, organizational, community and political influences.
The findings highlight the complex, interrelated relationships among multiple factors and subsequent limitations of behaviour-oriented health promotion strategies. To assist PWDs in making healthier choices, health promotion strategies need to direct attention to both individuals' behaviours and environmental conditions impacting the behaviours.
The findings of this review can inform multidisciplinary health practitioners' (including mental health nurses) practice with seniors living with mild-to-moderate dementia. We recommend actionable ways in which they can empower patients and their families in dementia management.
研究表明，非药物干预措施在改善或维持轻度至中度痴呆症患者（PWDs）的认知、情绪、功能、自我效能和生活质量方面具有有效性。这些干预措施在痴呆症的早期阶段至关重要。然而，加拿大和国际文献报道了这些干预措施的利用不足和获取困难的情况。
据我们所知，这是首次探讨影响老年人在痴呆症早期阶段使用非药物干预措施的因素的综述。该综述有助于发现一些独特的因素，如PWDs对非药物干预措施的信念、恐惧、认知和可接受性，以及环境对干预措施提供的影响。PWDs对干预措施的接受程度可能看似是与个人知识、信念和认知相关的个人选择问题。然而，对研究证据的分析表明，PWDs的选择受到多种环境因素的影响，如正式和非正式的照护者支持、非药物干预措施的可接受性和可及性、痴呆症护理人员、社区对痴呆症的态度以及资金。这些因素之间复杂的相互作用凸显了针对个人及其环境制定健康促进策略的重要性。
综述结果为医疗保健从业者（包括心理健康护士）在倡导PWDs基于证据的决策制定以及获取所需的非药物治疗方面提供了机会。通过持续评估健康和学习需求，以及使用干预措施的促进因素和障碍，让患者和家庭参与护理计划，持续提供信息，并向适当的服务进行个性化转诊，可以促进PWDs获得医疗保健的权利。
引言：尽管非药物干预措施在轻度至中度痴呆症的最佳管理中具有重要意义，但文献中仍不清楚轻度至中度痴呆症患者（PWDs）如何看待、理解和获取非药物干预措施。
本综述的目的是探讨有关影响社区居住的轻度至中度痴呆症老年人使用非药物干预措施的因素的证据的范围和性质。
按照多伦多和雷明顿（《进行综合综述的分步指南》，2020年）的指导进行综合综述，该指导扩展了托拉科（《人力资源开发评论》，2016年，第15卷，第404页）以及惠特莫尔和克纳夫（《高级护理杂志》，2005年，第52卷，第546页）的指导。
对16项研究的综述表明，PWDs对非药物干预措施的使用受到各种个人、人际、组织、社区和政治影响的复杂相互作用的影响。
研究结果突出了多个因素之间复杂的、相互关联的关系以及以行为为导向的健康促进策略的后续局限性。为了帮助PWDs做出更健康的选择，健康促进策略需要同时关注个人行为和影响这些行为的环境条件。
本综述的结果可以为多学科医疗保健从业者（包括心理健康护士）与轻度至中度痴呆症老年人的实践提供参考。我们推荐一些可行的方法，使他们能够在痴呆症管理中增强患者及其家庭的能力。
