Best practices interventions to improve quality of care of people with dementia living at home

OBJECTIVE: To identify effective interventions which improve quality of care for people with dementia (PwD) living at home.

METHODS: MEDLINE-(via PubMed), CINAHL, PsycINFO and ISI Web of Science databases were searched.

INCLUSION CRITERIA: (1) randomized controlled trials; (2) published in English-language, peer-reviewed journals between 1990 and 2012; (3) evaluated strategies to improve quality of care for PwD cared at home; and (4) participants older than 65.

RESULTS: 23 studies met inclusion criteria. All the studies aimed to improve PwD quality of care and most of them focused on PwD caregivers. Psychoeducational programs are the most frequently assessed interventions and multicomponent interventions produced the most promising results.

CONCLUSION: Due to the great variety of interventions describing specific samples and contexts, comparison of practice effectiveness is difficult. However, cognitive rehabilitation in PwD is effective when applied at an early stage of the disease. Case managers have demonstrated to reduce PwD institutionalization and the use of other community services. The studies were limited by sample heterogeneity, short follow-up or insufficiently detailed description.

PRACTICE IMPLICATIONS: To improve PwD homecare, health professionals should educate and support caregivers. Before specific interventional recommendations can be made, further research addressing the limitations of current studies is needed.