Comparative efficacy of non-pharmacological interventions on agitation in people with dementia: A systematic review and Bayesian network meta-analysis.

Abstract

BACKGROUND\nAgitation in people with dementia is common and distressing and can lead to increased caregiver burden. However, medications often have adverse reactions and limited effectiveness. Thus, non-pharmacological interventions are being increasingly implemented.\n\n\nOBJECTIVES\nTo compare and rank the efficacy of different non-pharmacological interventions in the management of agitation in people with dementia.\n\n\nDESIGN\nBayesian network meta-analysis.\n\n\nMETHODS\nA comprehensive electronic literature search was performed in five English databases and three Chinese databases to identify relevant randomized controlled trials (RCTs) that were published up to January 2019. A random-effects model was selected to conduct traditional meta-analysis to directly examine the efficacy of different non-pharmacological interventions. The consistency model was selected to conduct a network meta-analysis to evaluate the relative effects and rank probability of different non-pharmacological interventions.\n\n\nRESULTS\nA total of 65 RCTs were included in this network meta-analysis involving 11 different non-pharmacological interventions. Network meta-analysis showed that massage therapy, animal-assisted intervention, and personally tailored intervention were associated with more substantial reductions in agitation compared with other interventions and controls.\n\n\nCONCLUSIONS\nOur study confirmed the effectiveness of non-pharmacological interventions for ameliorating agitation in people with dementia and recommended several interventions for clinical practice. Healthcare professionals should be encouraged to apply promising non-pharmacological interventions (e.g. massage therapy, animal-assisted intervention and personally tailored intervention) for people with dementia during routine care.