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A R T I C L E I N F O A B S T R A C T
Article history: Many psychosocial intervention studies report effects in subgroups of people with dementia. Insight into
Received 25 May 2009 the characteristics of these subgroups is important for care practice.
Received in revised form 9 September 2009 This study reviews personal characteristics of people with dementia (living in the community or in an
Accepted 14 September 2009
institution) that are related to positive outcomes of psychosocial interventions. Electronic databases and
key articles were searched for effect studies published between January 1990 and February 2008.
Keywords: Outcome measures were clustered into categories such as cognitive functioning, behavioural
Dementia
functioning and mental health. Seventy-one studies showed positive outcomes on psychosocial
Information system
Care
interventions, such as decreased depression and less behavioural problems, related to personal
Welfare characteristics of people with dementia, such as gender, type or severity of dementia, presence of
Personalization behavioural or mental health problems, and living situation.
Outcome studies For people with dementia living in the community positive effects were most frequently found in the
persons with mild to severe dementia not otherwise specified and with mild to moderate Alzheimer’s
Disease. For people with dementia living in an institution positive effects were found most frequently in
the subgroups moderate to severe dementia, severe to very severe dementia and in the subgroup with
behavioural problems.
This study provides a unique overview of characteristics that are related to effective intervention
outcomes. It also suggests that more research will lead to a better understanding of which care and
welfare interventions are effective for specific subgroups of people with dementia.
ß 2009 Elsevier Ireland Ltd. All rights reserved.
1. Introduction not expected to grow at the same rate as the expected increase of
people with dementia.
The number of people who are over 65 years of age and In a recent large survey, persons with dementia reported unmet
diagnosed with dementia will rise over the next decades. It is needs most frequently in domains of information about their
estimated that 7.3 million people in Europe (Alzheimer Europe, health and available care and welfare services, memory support,
2009) and 24.3 million people worldwide have dementia today, company and psychological distress (Van der Roest et al., 2009a).
and that the number of people affected will almost double every 20 Reasons for not using the available care and welfare services are
years to 42.3 million in 2020 and 81.1 million people in 2040 (Ferri that persons with dementia and their caregivers are often unaware
et al., 2005). This growth will put a major claim on health care of the care offerings available to them, they find it difficult to
services, especially the diagnostic, therapeutic, and preventative choose between all the different care services and therefore tend
health care services provided for individuals in the community, as not to use them, have negative experiences with the care received
well as on welfare services that aim to socially support these because it does not fit their specific situation or wishes, or they
persons and their carers. Persons with dementia need a lot of care anticipate that the service offer will not meet their needs (Van der
and the main problem here is that the amount of available care is Roest et al., 2009b).
Unmet needs can lead to many negative outcomes such as
mood and behavioural problems, unsafe situations, social isolation
and higher mortality for patients (Gaugler et al., 2005).
* Corresponding author at: VU University Medical Center, Department of
Psychiatry, Alzheimer Center, EMGO Institute for Health and Care Research,
To be able to provide people with dementia with the
Valeriusplein 9, 1075 BG Amsterdam, The Netherlands. Tel.: +31 20 7885454. appropriate care, the offer of available care and welfare services
E-mail address: rm.droes@vumc.nl (R.M. Dröes). should be optimally tailored to the specific individual needs of
1568-1637/$ – see front matter ß 2009 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.arr.2009.09.002
164 L.D. Van Mierlo et al. / Ageing Research Reviews 9 (2010) 163–183
persons with dementia. We therefore recommend more detailed caused disagreement between the researchers were discussed
investigation of the effectiveness of care interventions for until they reached agreement on inclusion or exclusion. Disagree-
subgroups. The findings could also benefit healthcare professionals ment could occur when it was not fully clear from the abstract
who offer care to people with dementia, as they will gain more whether the criteria were met, e.g.: the abstract lacked details on
insight into the effectiveness of different psychosocial interven- the characteristics of subgroups. In those cases the full text article
tions for subgroups of people with dementia. Many reviews in the was considered and discussed to decide on inclusion or exclusion.
past (e.g. Eggermont and Scherder, 2006; Livingston et al., 2005; Seventy-one studies described effective interventions for
Smits et al., 2007) have tried to give an overview of effective persons with dementia. Forty-five were institution-based and 26
psychosocial interventions, but failed to systematically provide were community-based interventions.
information concerning characteristics of the subgroups for which
those interventions have proven to be beneficial in particular. This 3. Results
information is important for professional health carers to be able to
provide advice or effective care that is attuned to the needs of their 3.1. Outcome measures
individual clients.
The aim of this study is to identify which personal and Characteristics of community-dwelling people with dementia,
contextual features (characteristics) are relevant to promote a institutionalized people with dementia and positive effects on
more effective and efficient use of care and welfare services for outcome measures were described. Because effect sizes were often
subgroups of persons with dementia. This is expected to result in not mentioned in the traced articles, we decided to not include
people with dementia making more efficient and successful use of these in the tables. For each subgroup several different categories
care services. With this study, we will provide a unique and of outcome measures were distinguished. The interventions for
comprehensive overview of personal characteristics that are people with dementia were divided into community-based and
related to positive outcomes of psychosocial interventions. institution-based interventions. The interventions under study
Examples of personal characteristics and contextual factors that were aimed at many different outcome measures. These outcome
may be related to effective care are: severity and type of dementia, measures for people with dementia living in the community
and availability of caregivers. (community-based care) and for people with dementia living in an
To gain insight into characteristics that are related to effective institution were clustered into six categories: ‘‘Quality of Life’’,
intervention outcomes this literature review focuses on the ‘‘Cognitive Functioning’’, ‘‘Behavioural Functioning’’ ‘‘Mental
following research question: Health’’, ‘‘Physical Health’’ and ‘‘Other Positive Outcomes’’
(Tables 1 and 2, first column). The clusters were formed based
Which specific characteristics of persons with dementia or their partly on research by Van der Roest et al. (2007).
situations are related to positive outcomes of individual care
and welfare interventions? 3.2. Outcomes of effective interventions for people with dementia
living in the community
2. Method
Table 1 (column 2) shows an overview of the programmes for
2.1. Literature search procedure and studies on people with dementia living in the community
included in the review, as well as the characteristics of people with
To find out which personal characteristics of persons with dementia living in the community that relate to positive outcomes
dementia are related to predictors of effective care and support on specific needs categories. In the reviewed studies, most of the
interventions we performed a literature study. This study was positive intervention effects were found in the subgroups of people
limited to non-pharmacological interventions. with mild to moderate dementia, moderate to severe dementia
We started by searching the electronic databases of PubMed, (not otherwise specified) and mild to moderate AD. The positive
PsycINFO and Cinahl. The inclusion criteria were studies that intervention effects were most often found to be related to the
report on the effectiveness of care and welfare services used by outcome categories cognitive functioning and behavioural func-
people with dementia, as well as on the relation between outcomes tioning. The fewest positive effects were reported on the outcome
and personal context characteristics. An intervention was con- category physical health.
sidered effective when it had a statistically significant positive
outcome for people with dementia living in the community or in an 3.3. How to use the tables
institution. Reviews were aimed at two groups of subjects, i.e.
people with dementia living in the community and people with The tables can be used in multiple ways. First, the tables can be
dementia living in an institution. used to find the appropriate intervention for an unmet need of a
The search was limited to reviews published between January person with dementia living in the community. Step 1 is to locate
1990 and February 2008. To structure the literature search, we the desired outcome effect of an intervention in the first column
used three categories: ‘‘dementia’’, ‘‘person with dementia’’, and (effects column). After locating the problem or unmet need,
‘‘effective care and support’’. For each category a search strategy column 2 (intervention column) shows what intervention(s)
was developed, based on keywords (Mesh, Thesaurus and Tree) create(s) the desired outcome. The numbers in the row(s) directly
and free text words. More detailed information is available on to the right of the appropriate intervention correspond with the
request from the authors. number of the publication in which positive effects on subgroups
were described (see references). The subgroup characteristics
2.2. Search results described in the studies are indicated in the top of the column.
A different way of using the table is to start from a specific
The initial search resulted in a total of 269 reviews, of which 32 subgroup of people with dementia experiencing a specific
met the inclusion criteria. These reviews were further analyzed problem, and then find the intervention that is most effective
and resulted in a total of 170 studies that described effective care for them. Take, for example, people with moderate to severe
and welfare interventions for patients with dementia. The Alzheimer’s Disease who experience depression. Using the table
abstracts were double-checked by two researchers. Abstracts that will lead the reader to an intervention that was effective in
Table 1
Characteristics of people with dementia living at home related to effective intervention outcomes.
Effects Intervention
Quality of life
Increased well-being Reminiscence therapy 5
Increased positive affect Music Memory Lane 14 14
Video Memory Lane 14 14 14
Decreased boredom Multisensory stimulation/activity 1 1
group
Increased calmness Video respite therapy
165
166
Table 1 (Continued )
Mental health
Decreased depression Behavioural therapy
Nighttime Insomnia Treatment
and Education for Alzheimer’s
Disease (NITEAD)
Alzheimer rehabilitation by students
Behavioural therapy (pleasant events)
Meeting Centers Support program 90
Reducing Disability in Alzheimer’s
Disease (RDAD)
Decreased anxiety Progressive muscle relaxation
Absence of anxiety Association with companion animal
No hallucinations
Fewer mood disorders
Improved mood Multisensory stimulation/Activity 1 1
Increased alertness group 1 1
Increased self-esteem Meeting Centers Support program 90
Physical health
Improved physical health Reducing Disability in Alzheimer’s
Disease (RDAD)
Alzheimer rehabilitation by students
Increased strength
Decreased night wake time Nighttime Insomnia Treatment and
Decreased number of night awakenings Education for Alzheimer’s Disease
More exercise days (NITEAD)
Patient characteristics Alzheimer’s Probable Severity Behavioural Gender Other specific characteristics
Disease AD problems
Effects Intervention
Quality of life
Increased well-being Reminiscence therapy
Increased positive affect Music Memory Lane
Video Memory Lane
Decreased boredom Multisensory stimulation/
activity group
Increased calmness Video respite therapy 11
167
168
Table 1 (Continued )
Patient characteristics Alzheimer’s Probable Severity Behavioural Gender Other specific characteristics
Disease AD problems
Mental health
Decreased depression Behavioural therapy 18
Nighttime Insomnia Treatment 12
and Education for Alzheimer’s
Disease (NITEAD)
Alzheimer rehabilitation by 20
students
Behavioural therapy 77
(pleasant events)
Meeting Centers Support
program
Reducing Disability in 17
Alzheimer’s Disease (RDAD)
Decreased anxiety Progressive muscle relaxation 16
Absence of anxiety Association with companion 8
No hallucinations animal 8
Fewer mood disorders 8
Improved mood Multisensory stimulation/
Increased alertness Activity group
Increased self-esteem Meeting Centers Support
program
L.D. Van Mierlo et al. / Ageing Research Reviews 9 (2010) 163–183 169
12
awakenings
living with their caregiver, people with probable AD, people with
possible
were related to positive intervention effects: type and severity of characteristic of people with dementia living in the community
dementia, gender, presence of behavioural problems and living was related to positive intervention effects: type of dementia.
situation.
3.3.4. Mental health
3.3.3. Behavioural functioning Eight studies described interventions, namely behavioural
Behavioural functioning was further delineated by identifying therapy (Teri et al., 2003), Nighttime Insomnia Treatment and
the categories behavioural functioning (not otherwise specified), Education for Alzheimer’s Disease (NITEAD) (McCurry et al., 2005),
social behaviour, aggressive agitated behaviour and repetitive Alzheimer rehabilitation by students (Arkin, 2003), Behaviour
behaviour. therapy (pleasant events) (Teri, 1994), the Meeting Centres
Support Programme (Dröes et al., 2004b), Reducing Disability in
3.3.3.1. Behavioural functioning (not otherwise specified). Three Alzheimer’s Disease (RDAD) (Teri et al., 1997), association with a
studies described interventions, namely progressive muscle companion animal (Fritz et al., 1995), and multisensory stimula-
relaxation (Suhr, 1999), Meeting Centres Support Programme tion or activity group (Baker et al., 2001), that succeeded in
(Dröes et al., 2004b) and multisensory stimulation (Baker et al., improving mental health in subgroups of people with dementia
2001), that succeeded in improving behavioural functioning not living in the community (i.e. people with mild to moderate
otherwise specified in subgroups of people with dementia (i.e. dementia, people with moderate to severe dementia, people with
people with mild to moderate dementia, people with moderate to dementia and depression at baseline, people with dementia living
severe dementia, people with dementia living with their caregiver, with their caregiver, people with Alzheimer’s Disease, people with
people with probable AD and people with AD and behavioural mild to moderate AD, people with moderate to severe AD, people
problems). The following personal characteristics of people with with AD who spend much time with a companion animal and
dementia living in the community were related to positive people with AD who have a high attachment to a companion
intervention effects: type and severity of dementia, presence of animal). The following personal characteristics of people with
behavioural problems and living situation. dementia living in the community were related to positive
intervention effects: type and severity of dementia, presence of
3.3.3.2. Social behaviour. Six studies described interventions, depression and living situation.
namely the Meeting Centres Support Programme (Dröes et al.,
2004b), multisensory stimulation and activity group (Baker et al., 3.3.5. Physical health
2001), therapeutic recreation interventions at home (Fitzsim- Three studies described interventions, namely Reducing Dis-
mons and Buettner, 2002), Reducing Disability in Alzheimer’s ability in Alzheimer’s Disease (RDAD) (Teri et al., 1997), Alzheimer
Disease (RDAD) (Teri et al., 1997), Music Memory Lane and Video rehabilitation by students (Arkin, 2003) and Nighttime Insomnia
Memory Lane (Olsen et al., 2002), and association with a Treatment and Education for Alzheimer’s Disease (NITEAD)
companion animal (Fritz et al., 1995), that succeeded in improving (McCurry et al., 2005), that succeeded in improving physical
social behaviour in subgroups of people with dementia living in health for subgroups of people with dementia (i.e. people with
the community (i.e. people with mild to moderate dementia, dementia and agitation, people with Alzheimer’s Disease, people
people with moderate to severe dementia, people with dementia with mild to moderate AD, and people with moderate to severe
living with their carer, people with dementia participating in a AD). The following personal characteristics of people with
small or large intervention group, people with moderate to severe dementia living in the community were related to positive
AD and people with dementia who spend much time with a intervention effects: type and severity of dementia and presence
companion animal). The following personal characteristics of of agitation.
people with dementia living in the community were related to
positive intervention effects: type and severity of dementia and 3.3.6. Other positive outcomes
living situation. Five studies described interventions, namely Prince Henry
Hospital dementia caregiver’s training programme (Brodaty et al.,
3.3.3.3. Aggressive agitated behaviour. Three studies described 1997), Individual and family counselling (Mittelman et al., 1996),
interventions, namely home-based caregiver (skill) training Meeting Centres Support Programme (Dröes et al., 2004a,b), and
(Huang et al., 2003), association with a companion animal (Fritz reality orientation therapy (Metitieri et al., 2001), that resulted in
et al., 1995), and therapeutic recreation interventions at home the following other positive outcome: delay of nursing home
(Fitzsimmons and Buettner, 2002), that succeeded in decreasing placement for the subgroups of people with mild to moderate
aggressive agitation behaviour in subgroups of people with dementia and mild to moderate AD. The following personal
dementia living in the community (i.e. people with moderate to characteristics of people with dementia living in the community
severe dementia, people with dementia and behavioural problems, were related to positive intervention effects: type and severity of
people with dementia and agitation, people with dementia living dementia.
with their caregiver, people with Alzheimer’s Disease and people
who spend much time with a companion animal). The following 3.4. Outcomes of effective interventions for people with dementia
personal characteristics of people with dementia living in the living in an institution
community were related to positive intervention effects: type and
severity of dementia, presence of agitation, presence of beha- Table 2 (column 2) shows an overview of the programmes for
vioural problems and living situation. and studies on people with dementia living in an institution
included in the review, as well as the characteristics of people with
3.3.3.4. Repetitive behaviour. Two studies described interventions, dementia living in an institution that are related to positive
namely Carer training to implement behaviour management outcomes.
programmes (Bourgeois et al., 1997) and Music Memory Lane In all of the reported studies, most of the positive intervention
(Olsen et al., 2000), that succeeded in decreasing repetitive effects were found in the subgroups people with moderate to
behaviour in subgroups of people with dementia living in the severe, severe to very severe dementia (not otherwise specified)
community (i.e. people with dementia participating in a large and in people with behavioural problems. The positive interven-
intervention group and people with AD). The following personal tion effects were most frequently related to the outcome category
L.D. Van Mierlo et al. / Ageing Research Reviews 9 (2010) 163–183 171
behavioural functioning, especially aggressive and agitated beha- characteristics of people with dementia living in an institution
viour. The fewest positive effects were found on the outcome were related to positive interventions effects: type and severity of
category quality of life. dementia.
Patient characteristics Dementia Severity Behavioural problems Mental Health Problems Gender
Moderate Severe to Behavioural Agitation Aggression Disruptive Withdrawn Depression Bipolar Sleep Irregular Male Woman with
to severe very severe problems at pre- wandering behaviour at baseline disorders disorders sleep- gender primary
dementia dementia admission behaviour wake degenerative
rhythm dementia
Effects Intervention
Quality of life
Decreased discomfort Dementia special care
unit
Person-centered 48
showering
Towel bath 48
Sensory stimulation 83
activities
Decreased boredom Resident dog 38
173
174
Table 2 (Continued )
Institution-based care Type of dementia Dementia not specified
Patient characteristics Dementia Severity Behavioural problems Mental Health Problems Gender
Moderate Severe to Behavioural Agitation Aggression Disruptive Withdrawn Depression Bipolar Sleep Irregular Male Woman with
to severe very severe problems at pre- wandering behaviour at baseline disorders disorders sleep- gender primary
dementia dementia admission behaviour wake degenerative
rhythm dementia
Behavioural Functioning
aggressive agitated
behaviour
Decreased aggression Snoezel care plan 50
Release from mandatory 39 39 39 39
indoor confinement
Resident dog 38
Individually tailored 44 44
multidisciplinary 31 31
interventions
Walking program 32 32
Mental health
Improved mood Snoezel care plan 50
Music therapy
Reminiscence therapy
Decreased depression Individualized 46
multicomponent treatment
Physical health
Improved physical health Alzheimer rehabilitation
Increased strength by students
Regular exercise
Recreational interventions 86
Increased flexibility (sensorimotor program)
Increased sleep time Morning bright light therapy 40 40
Improved sleep behaviour Resident dog 38
Decreased sleep-wake Daytime social 43 43 43
rhythm disorders interaction with nurses
Increased nutritional Animal-assisted therapy
intake Nutritional program 76
Increased appetite Reminiscence therapy
175
176
Table 2 (Continued )
Institution-based care Type of dementia Dementia not specified
Patient characteristics Dementia Severity Behavioural problems Mental Health Problems Gender
Moderate Severe to Behavioural Agitation Aggression Disruptive Withdrawn Depression Bipolar Sleep Irregular Male Woman with
to severe very severe problems at pre- wandering behaviour at baseline disorders disorders sleep- gender primary
dementia dementia admission behaviour wake degenerative
rhythm dementia
High Agitated Moderate Aggression Mixed Admittance Alzheimer’s Mild to Moderate severe Repetitive Female Discharge Aggression Chair-
ADL behaviour to severe during intervention from nursing Disease moderate to severe to very disruptive gender to psycho- during bound
depen- during nursing bathing groups: home AD AD severe vocalizations geriatric bathing
dency evening depen- with/ environment dementia unit
hours dencies without
cognitive
disabilities
Effects Intervention
Quality of life
Decreased discomfort Dementia special care unit 51
Person-centered showering 48
Towel bath 48
Sensory stimulation activities
Decreased boredom Resident dog
More happy facial Simulated presence therapy
expressions
Improved interest
(affective reaction)
Increased affect Music during bathing 80 80
Cognitive functioning
speech problems
Improved production of Snoezel care plan
normal length sentences
Increased use of Alzheimer rehabilitation 20
Behavioural functioning
not otherwise specified
Decreased behavioural Sensory stimulation
disturbances (snoezelen)
Morning bright light 40
therapy
Daytime social interaction 43 43
with nurses
Special Care Units Program
Special Care Units (SCU)
A.G.E. Dementia Care Program
Expressive Physical Touch
with Verbalization (EPT/V)
Behavioural Management
Program
Skill elicitation 45 45
Reminiscence therapy 70
Behavioural functioning
social functioning
Improved social interaction Life review program
Music therapy 36
Improved socialization Snoezel care plan
behaviour Psychomotor Activation
Programme (PAP)
Animal-assisted therapy 27
Reminiscence therapy
Improved discourse 79
patterns
Improved decorum Snoezel care plan 50
Decreased socially Individually tailored
inappropriate behaviours multidisciplinary
Interventions
177
Resident dog
178
Table 2 (Continued )
Institution-based care Type of dementia Dementia not specified Alzheimer’s Disease
High Agitated Moderate Aggression Mixed Admittance Alzheimer’s Mild to Moderate severe Repetitive Female Discharge Aggression Chair-
ADL behaviour to severe during intervention from nursing Disease moderate to severe to very disruptive gender to psycho- during bound
depen- during nursing bathing groups: home AD AD severe vocalizations geriatric bathing
dency evening depen- with/ environment dementia unit
hours dencies without
cognitive
disabilities
Physical health
Improved physical health Alzheimer rehabilitation 20
Increased strength by students
Regular exercise 81 81
Recreational interventions
Increased flexibility (sensorimotor program)
Increased sleep time Morning bright light 40
therapy
Improved sleep behaviour Resident dog
Decreased sleep-wake Daytime social interaction 43
179
rhythm disorders with nurses
180 L.D. Van Mierlo et al. / Ageing Research Reviews 9 (2010) 163–183
bound
Female Discharge Aggression Chair-
described interventions, namely a snoezel care plan (Van Weert
et al., 2005), release from mandatory indoor confinement (McMinn
and Hinton, 2000), a resident dog (McCabe et al., 2002),
bathing
gender to psycho- during
individually tailored multidisciplinary interventions (Holm et al.,
1999; Opie et al., 2002), a walking programme (Holmberg, 1997),
person-centred showering and the towel bath (Sloane et al., 2004),
geriatric
unit
disruptive
Repetitive
problems
severe
51
51
1997), that succeeded in reducing aggressive, agitated behaviour in
Moderate
moderate to severe
Alzheimer’s Mild to
Alzheimer’s Disease
with/
48
48
48
nursing
dencies
depen-
evening
hours
Reminiscence therapy
Person-centered
Person-centered
Towel bath
showering
showering
Program
Unit
Increased nutritional
Decreased use of
tion (EPT/V) (Kim and Buschmann, 1999), Special Care Units (SCU)
(Bellelli et al., 1998), A.G.E. Dementia Care Program (Rovner et al.,
1996), release from mandatory indoor confinement (McMinn and
L.D. Van Mierlo et al. / Ageing Research Reviews 9 (2010) 163–183 181
Hinton, 2000), sensory stimulation (Witucki and Twibell, 1997), interventions. For people with dementia, regardless of whether
and an individualized multidisciplinary programme (Holm et al., they are living in the community or in an institution, character-
1999), that succeeded in improving mental health in subgroups of istics such as type and severity of dementia, gender, and the
people with dementia living in an institution (i.e. people with presence of behavioural problems or mental health problems
moderate to severe dementia, people with severe to very severe proved related to positive intervention outcomes, such as
dementia, people with dementia and behavioural problems, people decreased depression or decreased behavioural problems. Accord-
with dementia and moderate to severe nursing dependencies, ing to Smits et al. (2007) attention needs to be paid to the different
people with dementia participating in mixed intervention groups needs of subgroups of people with dementia. Dementia care should
of persons partly with and without cognitive disabilities, people focus on the diversity of needs of different target groups (for
with Alzheimer’s Disease, people with mild to moderate AD and instance, depressed persons with dementia (Smits et al., 2007)) for
people with AD that were discharged from a psychogeriatric unit). whom programmes may be most effective, in order to be able to
The following personal characteristics of people with dementia supply demand-directed care more efficiently and effectively.
living in an institution were related to positive intervention Characteristics that were frequently found to be related to
effects: type and severity of dementia, presence of behavioural positive intervention effects for people with dementia living in the
problems, composition of the intervention group, and discharge community are: type and severity of dementia and their living
outcome. situation. Characteristics that only few studies showed to be linked
with effective intervention outcomes are gender, presence of
3.4.5. Physical functioning depression, agitation, or behavioural problems, and whether or not
Ten studies described interventions, namely Alzheimer reha- people with dementia living in the community are currently using
bilitation by students (Arkin, 2003), morning bright light therapy care. For people with dementia living in an institution, type and
(Mishima et al., 1994), a resident dog (McCabe et al., 2002), severity of dementia, gender, presence of behavioural problems
daytime social interaction with nurses (Okawa et al., 1991), and presence of mental health problems, were often described to
reminiscence therapy (Gibson, 1994), animal-assisted therapy characterize the sample under study. Only a limited number of
(Edwards and Beck, 2002), a nutritional programme (Biernacki and studies, however, found characteristics such as depression,
Barrat, 2001), Recreational interventions (sensorimotor pro- agitation and aggression and ADL dependency, to be related to
gramme) (Buettner et al., 1996), regular exercise (Francese positive intervention outcomes.
et al., 1997) and person-centred showering or towel bath (Sloane Overall, in this review we were able to provide a relatively new
et al., 2004), that succeeded in improving physical health in and unique overview of the characteristics of people with
subgroups of people with dementia living in an institution (i.e. dementia that are related to effective intervention outcomes.
people with moderate to severe dementia, people with severe to Based on this knowledge, healthcare professionals will be better
very severe dementia, people with dementia and behavioural able to refer patients with specific characteristics to suitable
problems, people with dementia and sleep problems, people with interventions that are expected to be effective for them. Our results
dementia and irregular sleep-wake rhythms, people with demen- can be used in different ways. On the one hand, professionals can
tia and aggression during bathing, people with dementia start with an unmet need of a person with dementia and search for
participating in mixed intervention groups of persons partly with a linked intervention, and also find whether there is a specific
and without cognitive disabilities, people with Alzheimer’s characteristic that will increase the likelihood of success of that
Disease, people with mild to moderate AD and people with particular intervention. Or they can refer a person with dementia
moderate to severe AD). The following personal characteristics of from a specific subgroup, experiencing for instance mental health
people with dementia living in an institution were related to problems, to an intervention that is most likely to be effective. On
positive intervention effects: type and severity of dementia, the other hand, healthcare professionals that practice a certain
presence of behavioural problems, composition of the intervention intervention can use our table to identify specific subgroups of
group, and presence of mental health problems. people that could benefit in particular from that intervention.
There were several limitations to our research. Some of the studies
3.4.6. Other positive outcomes described more than one characteristic of persons that in
Three studies described interventions, namely Special Care combination were related to effective outcomes (Holm et al.,
Units (SCU) (Bellelli et al., 1998), A.G.E. Dementia Care Program 1999; Camberg et al., 1999). In these cases each characteristic was
(Rovner et al., 1996) and the Dementia Special Care Unit (Volicer considered independently related to the effective intervention
et al., 1994), that improved other positive outcomes (i.e. outcome(s). Within the time frame of our study it was impossible
‘‘decreased use of physical restraints’’, ‘‘lower mortality risk’’, to further investigate whether any of these characteristics
‘‘lower medication costs’’) in subgroups of people with dementia independently lead to a positive outcome on the interventions
living in an institution (i.e. people with severe to very severe in question.
dementia, people with dementia and behavioural problems and Although some studies found specific effects for certain
people with severe to very severe AD). The following personal subgroups of people with dementia or carers (Bourgeois, 1990;
characteristics of people with dementia living in an institution McCabe et al., 2002), many studies used a homogeneous sample of
were related to positive intervention effects: type and severity of participants. This led to, for instance, a positive intervention
dementia and presence of behavioural problems. outcome for people with Alzheimer’s disease, when it was not clear
what the effects would be for people with a different type of
4. Conclusion and discussion dementia.
Although this overview is already very helpful for professionals
In this study we tried to gain more insight into the in dementia care, the results of this study also mean that more
characteristics of people with dementia that may predict positive research should be conducted into characteristics that have not
effects of individual care and welfare interventions. We traced 76 been studied to date, such as education, loneliness, ethnic
studies that reported on the effectiveness of care and welfare background, and socio-economic status. Also, combinations of
interventions within subgroups of people with dementia. characteristics should be investigated, as well as those character-
We found different personal contextual characteristics of istics of subgroups of people with dementia that were not yet
people with dementia to be related to positive outcomes of included in outcome studies. We noticed, for instance, that many
182 L.D. Van Mierlo et al. / Ageing Research Reviews 9 (2010) 163–183
studies reported positive effects on cognitive functions in the 24 Bianchetti, A., Benvenuti, P., Ghisla, K.M., Frisoni, G.B., Trabucchi, M., 1997. An
Italian model of dementia special care unit: results of a pilot study. Alzheimer
subgroup of people with AD living at home, but relatively few Dis. Assoc. Disord. 11, 53–56.
studies reported positive effects on physical health in this same 76 Biernacki, C., Barrat, J., 2001. Improving the nutritional status of people with
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