Evidence indicates that there were various challenges in using non-medication treatments, known as non-pharmacological interventions (NPIs), to manage behavioural and psychological symptoms of dementia (BPSD) in residential aged-care homes (RACHs), based on input from residential aged-care home managers, care staff (e.g., nurses, caregivers), families of aged-care residents with dementia and volunteers.
The Review in Brief
Factors such as how well care staff know the interventions and residents with dementia, education and training for care staff and families of residents with dementia, the number of staff, available funding, available time, collaboration among care staff and families of residents with dementia, communication amongst the care staff and families of resident with dementia, beliefs about the effectiveness of NPIs and organisational support can all influence how well non-medication treatments for BPSD are implemented.
What Is This Review About?
NPIs are the best therapeutic option to manage BPSD. However, studies have shown that they are not being used as effectively as they could be. Even though there are many studies on what affects the use of NPIs for managing BPSD, no one has looked at all these studies together in a comprehensive way. This review looked at qualitative studies that explore why NPIs for managing BPSD are not always used well in residential aged care homes.
What Is the Aim of This Review?
This systematic review examines qualitative evidence on the factors influencing the implementation of NPIs for BPSD in residential aged care homes.
What Are the Main Findings of This Review?
What Studies Are Included?
Twenty-four published studies were included from which factors influencing the implementation of NPIs in residential aged care homes were extracted. Study participants included residential aged care home managers, residential aged care home staff, families of residents with dementia and volunteers. Amongst the studies specifying the gender of participants, there were 352 females (84.4%) and 46 males (15.6%). The method of data collection for the included studies consisted of 18 interviews, 5 focus group discussions and 1 qualitative survey. All except one study had a quality assessment score of at least 60%. However, all of these studies were included regardless of the result of the quality assessment. These studies spanned the period from 2010 to 2022 and were mostly conducted in the United Kingdom, Australia, the United States and Canada. Twenty-four synthesised findings (13 high, 7 moderate and 4 low ConQual scores) were identified in this review.
What Factors Influence the Implementation of NPIs?
Examples of factors influencing the implementation of NPIs were collaboration amongst care staff and families of residents with dementia, belief in the efficacy of interventions, staffing, funding, staff time constraints, familiarity with the interventions, organisational support, communication amongst the care staff and families of residents with dementia, education and training for care staff and families of residents with dementia and familiarity with residents with dementia.
What Do the Findings of This Review Mean?
For decision-makers, these insights suggest the need for potential comprehensive strategies to improve the implementation of NPIs. This could include ensuring adequate staffing, implementing strategies to improve collaboration amongst care staff, volunteers and families, ensuring adequate available funds, providing staff training, strengthening organisational support and ensuring the quality of information exchange amongst care staff, between care staff and volunteers and families of aged care residents with dementia. For researchers, the findings from this systematic review provide valuable insights including the need for exploring strategies to overcome barriers to the implementation of NPIs especially investigating innovative models for staffing and collaborative practice, examining the effectiveness of different education and training, exploring organisational policies and support mechanisms that can enhance the implementation of NPIs.
How Up-to-Date Is This Review?
We searched five major research databases: MEDLINE, EMCARE, EMBASE, CINAHL complete and APA PsycINFO up until 31 December 2023.