Psychosocial interventions for people with moderate to severe dementia: A systematic review

Introduction: Psychosocial interventions are recognised as important treatments for people with dementia. Attention is now focusing on the appropriateness of such interventions for people in different stages of the illness. Two recent systematic reviews have focused on psychosocial interventions for people with a milder dementia. This systematic review investigates the effectiveness of such interventions for people with moderate to severe dementia.

Methods: A comprehensive search was undertaken using all the major health care databases, as well as various grey literature sources. For studies to be included in the review, they must have investigated the effect of one or more psychosocial intervention on people with moderate to severe dementia, employing a controlled trial design and examining outcomes such as cognitive ability, communication, functional performance, well-being, physical performance, mobility, and disruptive behaviour. Identified studies were critically appraised, and where suitable for inclusion, data were extracted.

Results: Six studies met the final inclusion criteria for the review. The included studies covered five psychosocial interventions; multi-sensory stimulation, group exercise, reality orientation, combined walking and talking, and reminiscence therapy. No evidence was found for the effectiveness of reminiscence therapy and multi-sensory stimulation. The review provides some evidence for the effectiveness of exercise in increasing muscle strength; walking and talking, in slowing the decline in mobility; and reality orientation in improving cognitive ability in the short-term.

Conclusions: This review has revealed relatively few well-designed studies focusing on the effectiveness of psychosocial interventions for people with moderate and severe dementia. This highlights the need therefore for further multi-centre randomised controlled trials to be undertaken on these interventions, together with well-designed comparative and combined studies.