Anne Göhner1, Michael Hüll2, Sebastian Voigt-Radloff3. 1. Zentrum für Geriatrie und Gerontologie Freiburg, Universitätsklinikum Freiburg, Lehener Str. 88, 79106, Freiburg, Deutschland. anne.goehner@uniklinik-freiburg.de. 2. Klinik für Alterspsychiatrie und Psychotherapie, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychiatrie Emmendingen, Universitätsklinikum Freiburg, Emmendingen, Freiburg, Deutschland. 3. Cochrane Deutschland, Universitätsklinikum Freiburg, Freiburg, Deutschland.
Abstract
BACKGROUND: The number of persons suffering from dementia will continuously increase in the coming years; therefore, evidence-based interventions are needed in geriatric psychiatric care. When evidence is poor scoping reviews may help to identify knowledge gaps and needs for research. AIM OF THE ARTICLE: To present an overview of clinical trials on non-pharmacological treatment for elderly with dementia in hospitals, wards and nursing homes, specializing in gerontopsychiatric care. MATERIAL AND METHODS: A systematic search was carried out by one of the authors for clinical trials (randomized controlled, controlled and single group pre-post design, English and German, 1998-2014) in PsycINFO, PubMED, PSYNDEX and the Cochrane Library as well as a manual search in two relevant German peer-reviewed journals. Two authors included studies according to a priori defined inclusion criteria. One author extracted data after consulting the second author in cases of ambiguity. The risk of bias of the studies was not assessed. RESULTS AND DISCUSSION: A total of 77 studies were identified, 29 studies on restructured treatment pathways or settings, 14 trials on environmental changes and 34 studies on therapeutic single or group interventions. Both the methodological quality of the studies and the evidence for the efficacy of non-pharmacological treatment were limited. There are clear indications for an advantage of specialized environments and treatment settings for the elderly with dementia in hospitals, wards and nursing homes. There are consistent indications for positive effects of psychosocial activation alone or in combination with cognitive or physical activation, partly with high-quality study designs. This is consistent with the German S3 guidelines for dementia. For single interventions, such as electroconvulsive therapy or horticultural activities, the level of evidence remains limited.
BACKGROUND: The number of persons suffering from dementia will continuously increase in the coming years; therefore, evidence-based interventions are needed in geriatric psychiatric care. When evidence is poor scoping reviews may help to identify knowledge gaps and needs for research. AIM OF THE ARTICLE: To present an overview of clinical trials on non-pharmacological treatment for elderly with dementia in hospitals, wards and nursing homes, specializing in gerontopsychiatric care. MATERIAL AND METHODS: A systematic search was carried out by one of the authors for clinical trials (randomized controlled, controlled and single group pre-post design, English and German, 1998-2014) in PsycINFO, PubMED, PSYNDEX and the Cochrane Library as well as a manual search in two relevant German peer-reviewed journals. Two authors included studies according to a priori defined inclusion criteria. One author extracted data after consulting the second author in cases of ambiguity. The risk of bias of the studies was not assessed. RESULTS AND DISCUSSION: A total of 77 studies were identified, 29 studies on restructured treatment pathways or settings, 14 trials on environmental changes and 34 studies on therapeutic single or group interventions. Both the methodological quality of the studies and the evidence for the efficacy of non-pharmacological treatment were limited. There are clear indications for an advantage of specialized environments and treatment settings for the elderly with dementia in hospitals, wards and nursing homes. There are consistent indications for positive effects of psychosocial activation alone or in combination with cognitive or physical activation, partly with high-quality study designs. This is consistent with the German S3 guidelines for dementia. For single interventions, such as electroconvulsive therapy or horticultural activities, the level of evidence remains limited.
Authors: Arvid Skjerve; Fred Holsten; Dag Aarsland; Bjørn Bjorvatn; Harald A Nygaard; Inger Marie Johansen Journal: Psychiatry Clin Neurosci Date: 2004-08 Impact factor: 5.188
Authors: Antonios M Politis; Stephen Vozzella; Lawrence S Mayer; Chiadi U Onyike; Alva S Baker; Constantine G Lyketsos Journal: Int J Geriatr Psychiatry Date: 2004-11 Impact factor: 3.485
Authors: Tomislav Majić; Hans Gutzmann; Andreas Heinz; Undine E Lang; Michael A Rapp Journal: Am J Geriatr Psychiatry Date: 2013-07-03 Impact factor: 4.105
Authors: Michael A Rapp; Thomas Mell; Tomislav Majic; Yvonne Treusch; Johanna Nordheim; Mechthild Niemann-Mirmehdi; Hans Gutzmann; Andreas Heinz Journal: J Am Med Dir Assoc Date: 2013-07-01 Impact factor: 4.669
Authors: Clive Ballard; Ian Powell; Ian James; Katharina Reichelt; Pat Myint; Dawn Potkins; Carol Bannister; Marisa Lana; Robert Howard; John O'Brien; Alan Swann; Damian Robinson; Jay Shrimanker; Robert Barber Journal: Int J Geriatr Psychiatry Date: 2002-02 Impact factor: 3.485