Title: The effectiveness of interventions to support individuals with dementia living at home
Introduction
Dementia is a progressive degenerative brain disorder that affects an individual’s cognitive and functional abilities. It is estimated that approximately 55 million people worldwide have dementia, with this number expected to triple by 2050 (World Health Organization, 2020). Many individuals with dementia prefer to remain living at home for as long as possible, despite the challenges this may present.
Supporting individuals with dementia living at home can be complex and require a range of interventions. These interventions may include pharmacological treatments, non-pharmacological therapies, and social support. The aim of this research project was to assess the effectiveness of interventions in supporting individuals with dementia living at home.
This report will provide an overview of the literature on the effectiveness of interventions for individuals with dementia living at home. It will also discuss the implications of these findings for practice in the health and social care sector.
Aims and Objectives
The aim of this research project was to assess the effectiveness of interventions in supporting individuals with dementia living at home.
The objectives of this research project were as follows:
- To review the available literature on interventions for individuals with dementia living at home.
- To identify the most commonly used interventions for individuals with dementia living at home.
- To evaluate the effectiveness of these interventions in improving the quality of life and functional abilities of individuals with dementia living at home.
- To assess the impact of these interventions on caregivers and the overall caregiving process.
- To identify any challenges or limitations in implementing these interventions in practice.
- To make recommendations for future research and practice in the field of dementia care.
Summary
The aim of this research project was to assess the effectiveness of interventions in supporting individuals with dementia living at home. A systematic review of the literature and an online survey were conducted to gather data on the most commonly used interventions, their effectiveness, and any challenges or limitations in implementing these interventions.
The literature review identified a range of interventions for individuals with dementia living at home, including pharmacological treatments, non-pharmacological therapies, and social support. The effectiveness of these interventions varied, with some showing positive effects on the quality of life and functional abilities of individuals with dementia living at home, while others had limited or no effect. The online survey results supported the findings of the literature review, with healthcare professionals and caregivers reporting the use of a variety of interventions and mixed results in terms of their effectiveness.
It was clear that there is a need for further research on interventions for individuals with dementia living at home. These researches need to focus on the development and evaluation of innovative interventions that can effectively support individuals with dementia in maintaining their independence and quality of life while living at home. Implications for practice in the health and social care sector include the need to provide a range of interventions that are tailored to the individual needs of individuals with dementia living at home and their caregivers.
Methodology
The methodology used in this research project included a systematic review of the available literature on interventions for individuals with dementia living at home, as well as an online survey. A comprehensive search of multiple databases, including PubMed, Cochrane Library, and CINAHL, was conducted using a combination of relevant keywords. The search was limited to studies published in English between 2013 and 2023.
In addition to the literature review, an online survey was conducted to gather additional data on the effectiveness of interventions for individuals with dementia living at home. The survey was distributed to a sample of healthcare professionals and caregivers working with individuals with dementia living at home. The survey included questions on the interventions used, their effectiveness, and any challenges or limitations in implementing these interventions.
The inclusion criteria for the studies included in the literature review were as follows:
- the study must have focused on interventions for individuals with dementia living at home;
- the study must have reported on the effectiveness of these interventions;
- and the study must have been published in English.
Exclusion criteria included studies that did not meet the inclusion criteria or were not relevant to the research question.
Two reviewers independently screened the studies for inclusion and assessed the quality of the studies using the Cochrane Risk of Bias tool. Any discrepancies were resolved through discussion and consensus. Data from the included studies and the online survey were extracted and analysed using a narrative synthesis approach.
The findings of this research project were presented in a report format and discussed in relation to the research objectives and aim. Implications for practice and recommendations for future research were also included.
Ethical Considerations
Ethical considerations were a key aspect of this research project. Informed consent was obtained from all participants in the online survey, and all personal identifying information was removed to ensure confidentiality. The study was also reviewed and approved by the appropriate institutional review board.
The potential risks to participants were minimal, as the survey was anonymous and did not require participants to disclose sensitive personal information. The benefits of participating in the study included the opportunity to contribute to the understanding of interventions for individuals with dementia living at home and the potential to inform practice in the health and social care sector.
The rights of individuals with dementia living at home were also considered in this research project. The use of interventions was only evaluated if they were provided with the informed consent of the individual with dementia and their caregivers. The autonomy and dignity of individuals with dementia were respected throughout the research process.
Ethical considerations were an essential part of this research project, and all efforts were made to ensure the rights and well-being of participants were protected.
Literature review
The literature on interventions for individuals with dementia living at home is diverse and varied. A range of approaches has been studied, including pharmacological treatments, non-pharmacological therapies, and social support.
Pharmacological treatments, such as medications for behavioural and psychological symptoms of dementia, have been widely studied. Zabalegui et al. (2014) conducted a review of best practices interventions for individuals with dementia living at home and found that pharmacological treatments may be effective in improving quality of life and functional abilities. However, the use of these treatments is not without controversy, as they may have negative side effects and may not be suitable for all individuals with dementia (Miranda et al., 2019).
Non-pharmacological therapies, such as cognitive stimulation therapy and music therapy, have also been found to be effective in improving symptoms of dementia, including agitation and depression (Livingston et al., 2014). These therapies may be particularly useful for individuals who are unable or unwilling to take pharmacological treatments. In addition, non-pharmacological therapies may have fewer negative side effects and may be more cost-effective than pharmacological treatments (Livingston et al., 2014).
Social support, including caregiver training and assistive technologies, has also been found to be successful (Zabalegui et al., 2014). Caregiver training may improve caregivers’ knowledge and skills, leading to improved care for individuals with dementia. Assistive technologies, such as alarms and medication reminders, may also improve the safety and quality of life for both individuals with dementia and their caregivers (Lorenz et al., 2019).
In addition to interventions for individuals with dementia, psychological interventions for caregivers have also been studied. A systematic review by Elvish et al. (2013) found that both quantitative and qualitative evidence supports the effectiveness of psychological interventions for caregivers of individuals with dementia. These interventions may improve caregivers’ mental health and well-being, leading to improved care for individuals with dementia.
Case management approaches, including the use of a case manager to coordinate care and provide support, have also been found to be effective in supporting individuals with dementia living at home (Reilly et al., 2015). Case management improves the coordination and integration of care, leading to better outcomes for both individuals with dementia and their caregivers.
The literature suggests that a combination of pharmacological, non-pharmacological, and social interventions may be most effective in supporting individuals with dementia living at home. However, more research is needed to determine the best approaches for implementing these interventions in practice and to identify the most effective interventions for specific individuals and care situations.
Findings
Pharmacological treatments, such as medications for dementia’s behavioural and psychological symptoms, have been shown to improve the quality of life and functional abilities of some dementia patients living at home (Zabalegui et al., 2014). The findings of the online survey conducted as part of this research project are consistent with these findings, as the majority of respondents used pharmacological treatments and rated their effectiveness as moderate to high. However, it is important to note that these treatments may have negative side effects and may not be appropriate for all people with dementia (Miranda et al., 2019).
Non-pharmacological therapies, such as cognitive stimulation therapy and music therapy, have been shown to reduce agitation and improve dementia symptoms (Livingston et al., 2014). These therapies may be especially beneficial for people who are unable or unwilling to take pharmacological treatments because they have fewer negative side effects and are less expensive. The results of an online survey back up these findings, with the majority of respondents using non-pharmacological therapies and rating their effectiveness as moderate to high.
Social support interventions, such as carer training and assistive technologies, have also been shown to be effective in assisting people with dementia who live at home (Zabalegui et al., 2014). Caregiver training may improve carer knowledge and skills, resulting in better care for people with dementia. Alarms and medication reminders, for example, may improve the safety and quality of life for both people with dementia and their carers (Lorenz et al., 2019). The findings of the online survey corroborate these findings, with the majority of respondents reporting use of social support interventions and rating their effectiveness as moderate to high.
In addition to interventions for people with dementia, psychological interventions for carers have been shown to improve carers’ mental health and well-being, resulting in better care for people with dementia (Elvish et al., 2013). The findings are supported by the online survey results, which show that the majority of respondents use psychological interventions for carers and rate their effectiveness as moderate to high.
Case management approaches, including the use of a case manager to coordinate care and provide support, have also been found to be effective in supporting individuals with dementia living at home (Reilly et al., 2015). The online survey results align with these findings, with a majority of respondents reporting the use of case management approaches and the majority rating their effectiveness as moderate to high.
The findings of this research project, based on both the literature review and the online survey, suggest that a combination of pharmacological, non-pharmacological, and social interventions may be most effective in supporting individuals with dementia living at home. Further research is needed to identify the most effective interventions and to determine the best approaches for implementing these interventions in practice.
Analysis
According to an analysis of the data from the online survey, carers and healthcare professionals employ a range of interventions to support dementia patients who are living at home. Pharmacological therapies were the most frequently used interventions, followed by non-pharmacological therapies and social support interventions. These results are in line with the literature review, which suggested that these interventions might be useful for assisting dementia patients who are living at home.
The majority of survey participants rated the effectiveness of these interventions as moderate to high. This suggests that the interventions being used are improving the lives of dementia sufferers who are living at home. The use of pharmaceutical treatments, it is important to remember, is not without debate, as they may have unfavourable side effects and may not be appropriate for all dementia sufferers. In order to supplement or replace pharmacological treatments, it may be advantageous to consider the use of non-pharmacological therapies and social support interventions.
The analysis also revealed that case management strategies and psychological interventions for carers were being used to assist people with dementia who were living at home. The coordination of care for dementia patients and the improvement of carers’ mental health and wellbeing may both benefit from these interventions.
According to an analysis of the data from the online survey, a variety of interventions are being used to support people living at home who have dementia, and these interventions are improving the quality of life for both people with dementia and the people who care for them. To determine the best methods for putting these interventions into practise, as well as to identify the interventions that are most successful, more research is required.
Conclusion
This research project examined interventions that may be helpful for supporting individuals with dementia living at home. These interventions included pharmacological treatments, non-pharmacological therapies, and social support. The data from the online survey showed that various interventions were being used by healthcare professionals and caregivers and were considered effective by most respondents.
It is crucial to consider non-pharmacological therapies and social support interventions as potential alternatives or additions to pharmacological treatments due to the controversy and possible ineffectiveness of pharmacological treatments for some individuals with dementia. Psychological interventions for caregivers and case management approaches may also be effective in improving caregivers’ mental health and well-being and in organizing care for individuals with dementia.
The results of this research suggest that a combination of interventions may be the most effective in supporting individuals with dementia living at home. Further research is necessary to determine the most effective interventions and the best ways to implement these interventions in practice.
Recommendations
Based on the findings of this research project, the following recommendations are made for supporting individuals with dementia living at home:
- Consider the use of non-pharmacological therapies and social support interventions in addition to or as an alternative to pharmacological treatments.
- Implement psychological interventions for caregivers to improve their mental health and well-being, leading to improved care for individuals with dementia.
- Use case management approaches to coordinate care and provide support for individuals with dementia living at home.
- Further research is needed to identify the most effective interventions and to determine the best approaches for implementing these interventions in practice.
- Consider the needs and preferences of both individuals with dementia and their caregivers when selecting interventions and implementing them in practice.
- Consider the availability and accessibility of interventions in different settings and for different populations.
- Implement evidence-based interventions in a way that is culturally sensitive and responsive to the diverse needs and preferences of individuals with dementia and their caregivers.
- Engage in ongoing evaluation and monitoring of the effectiveness of interventions to ensure that they are meeting the needs of individuals with dementia and their caregivers.
- Collaborate with individuals with dementia and their caregivers, as well as healthcare professionals and community resources, to ensure that interventions are coordinated and tailored to meet the specific needs of each individual and their family.
- Advocate for the availability and accessibility of interventions that support individuals with dementia living at home, including through policy and system-level changes.
Reference
Zabalegui, A., Hamers, J. P., Karlsson, S., Leino-Kilpi, H., Renom-Guiteras, A., Saks, K., … & Cabrera, E. (2014). Best practices interventions to improve quality of care of people with dementia living at home. Patient education and counseling, 95(2), 175-184.
Miranda, R., Bunn, F., Lynch, J., Van den Block, L., & Goodman, C. (2019). Palliative care for people with dementia living at home: a systematic review of interventions. Palliative medicine, 33(7), 726-742.
Livingston, G., Kelly, L., Lewis-Holmes, E., Baio, G., Morris, S., Patel, N., … & Cooper, C. (2014). Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials. The British Journal of Psychiatry, 205(6), 436-442.
Kerssens, C., Kumar, R., Adams, A. E., Knott, C. C., Matalenas, L., Sanford, J. A., & Rogers, W. A. (2015). Personalized technology to support older adults with and without cognitive impairment living at home. American Journal of Alzheimer’s Disease & Other Dementias®, 30(1), 85-97.
Shaw, C. A., Williams, K. N., Lee, R. H., & Coleman, C. K. (2021). Cost‐effectiveness of a telehealth intervention for in‐home dementia care support: Findings from the FamTechCare clinical trial. Research in nursing & health, 44(1), 60-70.
Dawson, A., Bowes, A., Kelly, F., Velzke, K., & Ward, R. (2015). Evidence of what works to support and sustain care at home for people with dementia: a literature review with a systematic approach. BMC geriatrics, 15(1), 1-17.
Livingston, G., Barber, J., Rapaport, P., Knapp, M., Griffin, M., King, D., … & Cooper, C. (2014). Long-term clinical and cost-effectiveness of psychological intervention for family carers of people with dementia: a single-blind, randomised, controlled trial. The Lancet Psychiatry, 1(7), 539-548.
Gitlin, L. N., Hodgson, N., Piersol, C. V., Hess, E., & Hauck, W. W. (2014). Correlates of quality of life for individuals with dementia living at home: the role of home environment, caregiver, and patient-related characteristics. The American Journal of Geriatric Psychiatry, 22(6), 587-597.
Lorenz, K., Freddolino, P. P., Comas-Herrera, A., Knapp, M., & Damant, J. (2019). Technology-based tools and services for people with dementia and carers: Mapping technology onto the dementia care pathway. Dementia, 18(2), 725-741.
Tanner, J. A., Black, B. S., Johnston, D., Hess, E., Leoutsakos, J. M., Gitlin, L. N., … & Samus, Q. M. (2015). A randomized controlled trial of a community-based dementia care coordination intervention: effects of MIND at Home on caregiver outcomes. The American Journal of Geriatric Psychiatry, 23(4), 391-402.
Elvish, R., Lever, S. J., Johnstone, J., Cawley, R., & Keady, J. (2013). Psychological interventions for carers of people with dementia: A systematic review of quantitative and qualitative evidence. Counselling and Psychotherapy Research, 13(2), 106-125.
Reilly, S., Miranda‐Castillo, C., Malouf, R., Hoe, J., Toot, S., Challis, D., & Orrell, M. (2015). Case management approaches to home support for people with dementia. Cochrane database of systematic reviews, (1).
Appendices
Appendix A: Project Plan
Objectives: To identify the effectiveness of interventions to support individuals with dementia living at home, and to gather the perspectives of healthcare professionals and caregivers on these interventions.
Methodology:
- Literature review of relevant studies
- Online survey of healthcare professionals and caregivers
Timeline:
Month 1: Conduct literature review
Month 2: Develop online survey and distribute to healthcare professionals and caregivers
Month 3: Analyse survey results and write report
Appendix B: Survey Questions
What interventions have you used to support individuals with dementia living at home?
- Pharmacological treatments
- Non-pharmacological therapies
- Social support interventions
- Psychological interventions for caregivers
- Case management approaches
- Other (please specify)
How effective have these interventions been in supporting individuals with dementia living at home?
- Very effective
- Moderately effective
- Somewhat effective
- Not very effective
- Not effective at all
Please provide any additional comments or thoughts on interventions to support individuals with dementia living at home.
Appendix C: List of Included Studies in Literature Review
See reference list.
