Effectiveness of nonpharmacological interventions in delaying the institutionalization of patients with dementia: a meta-analysis

Spijker, Anouk; Vernooij‐Dassen, Myrra; Vasse, Emmelyne; Adang, Eddy; Wollersheim, Hub; Grol, Richard; Verhey, Frans

doi:10.1111/j.1532-5415.2008.01705.x

Cited by 223Dementia and Cognitive Impairment ResearchGeriatric Care and Nursing HomesPalliative Care and End-of-Life Issues

Effectiveness of nonpharmacological interventions in delaying the institutionalization of patients with dementia: a meta-analysis

Spijker, Anouk, Vernooij‐Dassen, Myrra, Vasse, Emmelyne, Adang, Eddy, Wollersheim, Hub, Grol, Richard, Verhey, Frans·2008·Journal of the American Geriatrics Society

DOI 10.1111/j.1532-5415.2008.01705.x

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Abstract

Contemporary healthcare policies are designed to shape the conditions that can help delay the institutionalization of patients with dementia. This can be done by developing support programs that minimize healthcare risks for the patients with dementia and their informal caregivers. Many support programs have been developed, and some of them are effective, but there has been no systematic review with a meta-analysis of all types of nonpharmacological support programs with odds of institutionalization or time to institutionalization as an outcome measure. A systematic review with a meta-analysis was therefore conducted to estimate the overall effectiveness of nonpharmacological support programs for caregivers and patients with dementia that are intended to delay institutionalization. Thirteen support programs with a total of 9,043 patients were included in the meta-analyses. The estimated overall effectiveness suggests that these programs significantly decrease the odds of institutionalization (odds ratio (OR)=0.66, 95% confidence interval (CI)=0.43-0.99, P=.05) and significantly increase the time to institutionalization (standardized mean difference (SMD)=1.44, 95% CI=0.07-2.81, P=.04). A meta-analysis of the best-quality studies still showed a positive significant result for the odds of institutionalization (OR=0.60, 95% CI=0.43-0.85, P=.004), although the time to institutionalization was no longer significant (SMD=1.55, 95% CI=-0.35- 3.45, P=.11). The analysis of the intervention characteristics showed that actively involving caregivers in making choices about treatments distinguishes effective from ineffective support programs. Further investigation should be directed toward calculating the potential efficiency of these support programs by applying net-benefit or cost-effectiveness analysis.

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Specialist, individually tailored, psychological support to people with dementia and their family carers has been shown to reduce the rate of, although not necessarily the time to, care home admission in the USA, although there is no evidence in the UK.
“Specialist, individually tailored, psychological support to people with dementia and their family carers has been shown to reduce the rate of, although not necessarily the time to, care home admission in the USA, although there is no evidence in the UK.10,11”
From START (STrAtegies for RelaTives) study: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia (2014) · cites this paper as [11]
Only multicomponent interventions have been shown to be effective in preventing institutionalisation.
“Only multicomponent interventions have been shown to be effective in preventing institutionalisation.11,12”
From START (STrAtegies for RelaTives) study: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia (2014) · cites this paper as [11]
There is evidence from systematic reviews that therapies individualised to the carer receiving them are most effective in delaying institutionalisation, and that individual behavioural therapies are more effective than group interventions in reducing carer morbidity.
“There is evidence from systematic reviews that therapies individualised to the carer receiving them are most effective in delaying institutionalisation,11 and that individual behavioural therapies are more effective than group interventions in reducing carer morbidity.10”
From START (STrAtegies for RelaTives) study: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia (2014) · cites this paper as [11]
There is some evidence that carer support can reduce institutionalisation and that therapies such as the Coping with Caregiving programme, which include problem-solving strategies and offer carers a choice of support strategies tailored to individual needs, are most effective.
“a recent systematic review finds that there is some evidence that carer support can reduce institutionalisation and that therapies such as the Coping with Caregiving programme, which include problem-solving strategies and offer carers a choice of support strategies which can be tailored to their individual needs, are most effective.11”
From START (STrAtegies for RelaTives) study: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia (2014) · cites this paper as [11]

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Authors: Spijker, A., Vernooij‐Dassen, M., Vasse, E., Adang, E., Wollersheim, H., Grol, R., & Verhey, F.
Affiliations: Radboud University Nijmegen (NL)
Corresponding author: Spijker, Anouk
ORCID: Adang, Eddy
Verhey, Frans
Venue: Journal of the American Geriatrics Society
Publisher: Wiley
Published: 2008-04-11
Volume: 56
Issue: 6
Pages: 1116-1128
ISSN: 0002-8614 (ISSN-L)
1532-5415
DOI: 10.1111/j.1532-5415.2008.01705.x
OpenAlex: W2139614216
Cited by: 223
References: 26
Citations by year: 2026: 8 · 2025: 4 · 2024: 6 · 2023: 8 · 2022: 7 · 2021: 8 · 2020: 22 · 2019: 15 · 2018: 16 · 2017: 19 · 2016: 17 · 2015: 11 · 2014: 17 · 2013: 9 · 2012: 14
FWCI: 1.81
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Journal of the American Geriatrics Society (publishedVersion)
PubMed (publishedVersion)
Radboud Repository (Radboud University) (submittedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Keywords: dementia, institutionalization, non-pharmacological treatment, caregiver support programs, informal caregivers, healthcare policy
MeSH terms: Aged, Australia, Dementia, Europe, Humans, North America, Social Support, Treatment Outcome, Caregivers, Disease Management

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Effectiveness of nonpharmacological interventions in delaying the institutionalization of patients with dementia: a meta-analysis

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