Effectiveness of interventions on the quality of life of people with major neurocognitive disorder (dementia) in residential long-term care: a systematic review

Background: Dementia is a syndrome that indicates progressive decline in a person’s cognition and functioning. The goal of dementia care needs to focus on living well with dementia, which can be measured through assessing quality of life as there is currently no cure for dementia. Objectives: The aim of this systematic review was to identify which interventions had the best outcomes to improve the quality of life of people with dementia living in residential long- term care facilities. Method: Studies that examined effects of interventions on quality of life of residents with dementia in long-term care were explored. Studies with outcomes of interventions measured using valid quality of life measurement instruments were considered eligible for this review. Published and unpublished literature from 1995 to 2014 in English was searched through electronic databases. The methodological quality of eligible studies was assessed and data of included studies were extracted by two independent reviewers using the Joanna Briggs Institute instruments. All findings were summarised in narrative form. Where the data of comparable studies lacked statistical difference, statistical pooling was used for meta-analysis with the software developed by the Joanna Briggs Institute. Result: After a comprehensive search throughout relevant databases and quality appraisal of eligible studies, 19 studies were identified for this review. Interventions were categorised into six types according to features of interventions: reminiscence, staff training, cognitive stimulation therapy, physical exercise, pharmacology-related treatment, and other interventions. The data from studies with respect to reminiscence, staff training and cognitive stimulation therapy were pooled for meta-analysis, but the pooled results did not show significant effects of intervention of interest. Conclusion: The review showed that reminiscence, staff training, physical exercise, cognitive stimulation therapy, music, companion- robot, and aromatherapy may have benefit in improving the QOL or wellbeing of people with dementia in residential long- term care, however, the evidence is of low to moderate grade. Recommendations include further research in this field and a person-centred approach to interventions and monitoring of quality of life of people in residential long-term care.