Introduction: Nonpharmacological therapies (NPTs) can improve the quality of life (QoL) of people with Alzheimer’s disease (AD) and their carers. The objective of this study was to evaluate the best evidence on the effects of NPTs in AD and related disorders (ADRD) by performing a systematic review and meta-analysis of the entire field. Methods: Existing reviews and major electronic databases were searched for randomized controlled trials (RCTs). The deadline for study inclusion was September 15, 2008. Intervention categories and outcome domains were predefined by consensus. Two researchers working together detected 1,313 candidate studies of which 179 RCTs belonging to 26 intervention categories were selected. Cognitive deterioration had to be documented in all participants, and degenerative etiology

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Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy

Objective To provide an overview of non-pharmacological interventions for behavioural and psychological symptoms in dementia (BPSD). Design Systematic overview of reviews. Data sources PubMed, EMBASE, Cochrane Database of Systematic Reviews, CINAHL and PsycINFO (2009–March 2015). Eligibility criteria Systematic reviews (SRs) that included at least one comparative study evaluating any non-pharmacological intervention, to treat BPSD. Data extraction Eligible studies were selected and data extracted independently by 2 reviewers. The AMSTAR checklist was used to assess the quality of the SRs. Data analysis Extracted data were synthesised using a narrative approach. Results 38 SRs and 142 primary studies were identified, comprising the following categories of non-pharmacological interventions: (1) sensory stimulation interventions (12 SRs, 27 primary studies) that encompassed: acupressure, aromatherapy, massage/touch therapy, light therapy and sensory garden; (2) cognitive/emotion-oriented interventions (33 SRs; 70 primary studies) that included cognitive stimulation, music/dance therapy, dance therapy, snoezelen, transcutaneous electrical nerve stimulation, reminiscence therapy, validation therapy, simulated presence therapy; (3) behaviour management techniques (6 SRs; 32 primary studies) and (4) other therapies (5 SRs, 12 primary studies) comprising exercise therapy, animal-assisted therapy, special care unit and dining room environment-based interventions. Music therapy was effective in reducing agitation (SMD, −0.49; 95% CI −0.82 to −0.17; p=0.003), and anxiety (SMD, −0.64; 95% CI −1.05 to −0.24; p=0.002). Home-based behavioural management techniques, caregiver-based interventions or staff training in communication skills, person-centred care or dementia care mapping with supervision during implementation were found to be effective for symptomatic and severe agitation. Conclusions A large number of non-pharmacological interventions for BPSD were identified. The majority of the studies had great variation in how the same type of intervention was defined and applied, the follow-up duration, the type of outcome measured, usually with modest sample size. Overall, music therapy and behavioural management techniques were effective for reducing BPSD.

https://bmjopen.bmj.com/content/bmjopen/7/3/e012759.full.pdf

Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series.

Objective With an elderly population that is set to more than double by 2050 worldwide, there will be an increased demand for elderly care. This poses several impediments in the delivery of high-quality health and social care. Socially assistive robot (SAR) technology could assume new roles in health and social care to meet this higher demand. This review qualitatively examines the literature on the use of SAR in elderly care and aims to establish the roles this technology may play in the future. Design Scoping review. Data sources Search of CINAHL, Cochrane Library, Embase, MEDLINE, PsychINFO and Scopus databases was conducted, complemented with a free search using Google Scholar and reference harvesting. All publications went through a selection process, which involved sequentially reviewing the title, abstract and full text of the publication. No limitations regarding date of publication were imposed, and only English publications were taken into account. The main search was conducted in March 2016, and the latest search was conducted in September 2017. Eligibility criteria The inclusion criteria consist of elderly participants, any elderly healthcare facility, humanoid and pet robots and all social interaction types with the robot. Exclusions were acceptability studies, technical reports of robots and publications surrounding physically or surgically assistive robots. Results In total, 61 final publications were included in the review, describing 33 studies and including 1574 participants and 11 robots. 28 of the 33 papers report positive findings. Five roles of SAR were identified: affective therapy, cognitive training, social facilitator, companionship and physiological therapy. Conclusions Although many positive outcomes were reported, a large proportion of the studies have methodological issues, which limit the utility of the results. Nonetheless, the reported value of SAR in elderly care does warrant further investigation. Future studies should endeavour to validate the roles demonstrated in this review. Systematic review registration NIHR 58672.

https://bmjopen.bmj.com/content/bmjopen/8/2/e018815.full.pdf

Scoping review on the use of socially assistive robot technology in elderly care

Purpose of the study During aging, musical activities can help maintain physical and mental health and cognitive abilities, but their rehabilitative use has not been systematically explored in persons with dementia (PWDs). Our aim was to determine the efficacy of a novel music intervention based on coaching the caregivers of PWDs to use either singing or music listening regularly as a part of everyday care. Design and methods Eighty-nine PWD-caregiver dyads were randomized to a 10-week singing coaching group (n = 30), a 10-week music listening coaching group (n = 29), or a usual care control group (n = 30). The coaching sessions consisted primarily of singing/listening familiar songs coupled occasionally with vocal exercises and rhythmic movements (singing group) and reminiscence and discussions (music listening group). In addition, the intervention included regular musical exercises at home. All PWDs underwent an extensive neuropsychological assessment, which included cognitive tests, as well as mood and quality of life (QOL) scales, before and after the intervention period and 6 months later. In addition, the psychological well-being of family members was repeatedly assessed with questionnaires. Results Compared with usual care, both singing and music listening improved mood, orientation, and remote episodic memory and to a lesser extent, also attention and executive function and general cognition. Singing also enhanced short-term and working memory and caregiver well-being, whereas music listening had a positive effect on QOL. Implications Regular musical leisure activities can have long-term cognitive, emotional, and social benefits in mild/moderate dementia and could therefore be utilized in dementia care and rehabilitation.

Cognitive, Emotional, and Social Benefits of Regular Musical Activities in Early Dementia: Randomized Controlled Study

Effects of music therapy on behavioral and psychological symptoms of dementia: a systematic review and meta-analysis.

Aim. This article reports the results of a study evaluating a preferred music listening intervention for reducing anxiety in older adults with dementia in nursing homes.

Background.  Anxiety can have a significant negative impact on older adults’ functional status, quality of life and health care resources. However, anxiety is often under-diagnosed and inappropriately treated in those with dementia. Little is known about the use of a preferred music listening intervention for managing anxiety in those with dementia.

Design.  A quasi-experimental pretest and posttest design was used.

Methods.  This study aimed to evaluate the effectiveness of a preferred music listening intervention on anxiety in older adults with dementia in nursing home. Twenty-nine participants in the experimental group received a 30-minute music listening intervention based on personal preferences delivered by trained nursing staff in mid-afternoon, twice a week for six weeks. Meanwhile, 23 participants in the control group only received usual standard care with no music. Anxiety was measured by Rating Anxiety in Dementia at baseline and week six. Analysis of covariance (ancova) was used to determine the effectiveness of a preferred music listening intervention on anxiety at six weeks while controlling for pretest anxiety, age and marital status.

Results. ancova results indicated that older adults who received the preferred music listening had a significantly lower anxiety score at six weeks compared with those who received the usual standard care with no music (F = 12·15, p = 0·001).

Conclusions.  Preferred music listening had a positive impact by reducing the level of anxiety in older adults with dementia.

Relevance to clinical practice.  Nursing staff can learn how to implement preferred music intervention to provide appropriate care tailored to the individual needs of older adults with dementia. Preferred music listening is an inexpensive and viable intervention to promote mental health of those with dementia.

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A preferred music listening intervention to reduce anxiety in older adults with dementia in nursing homes.

http://msn.iecs.fcu.edu.tw/report/data/ori_paper/2005-9-29/A%20fast%20edge-oriented%20algorithm%20for%20image%20interpolation.pdf

A fast edge-oriented algorithm for image interpolation

The effects of group music with movement intervention on agitated behaviours of institutionalized elders with dementia in Taiwan

Introduction

Animal-assisted therapy is gaining popularity as part of therapeutic activities for older adults in many long-term care facilities. However, concerns about dog bites, allergic responses to pets, disease, and insufficient available resources to care for a real pet have led to many residential care facilities to ban this therapy. There are situations where a substitute artificial companion, such as robotic pet, may serve as a better alternative.



Methods

This pilot study used a one-group pre- and posttest design to evaluate the effect of a robot-assisted therapy for older adults. Sixteen eligible participants participated in the study and received a group robot-assisted therapy using a seal-like robot pet for 30 minutes twice a week for 4 weeks. All participants received assessments of their communication and interaction skills using the Assessment of Communication and Interaction Skills (ACIS-C) and activity participation using the Activity Participation Scale at baseline and at week 4.



Results

A total of 12 participants completed the study. Wilcoxon signed rank test showed that participants' communication and interaction skills (z = −2.94, P = 0.003) and activity participation (z = −2.66, P = 0.008) were significantly improved after receiving 4-week robot-assisted therapy.



Discussion

By interacting with a robot pet, such as Paro, the communication, interaction skills, and activity participation of the older adults can be improved. The robot-assisted therapy can be provided as a routine activity program and has the potential to improve social health of older adults in residential care facilities.

Robot‐assisted therapy for improving social interactions and activity participation among institutionalized older adults: A pilot study

Aims. This study aimed to explore nursing staff’s attitudes and use of music for older people with dementia in long-term care facilities.

Background.  Music has shown positive outcomes in managing behavioural symptoms of older people with dementia. Older people living in long-term care facilities often do not have access to trained music therapists. Nursing staff provide the majority of direct care for institutionalised older people with dementia, therefore, will be the most appropriate personnel to learn and implement music therapy for those with dementia. To date, no studies have explored nursing staff’s attitudes and use of music for those with dementia.

Design.  A cross-sectional research design was used.

Methods.  A convenience sample of 285 nursing staff caring for those with dementia in long-term care facilities in Taiwan were recruited. Participants received a self-administered questionnaire consisted of items exploring nursing staff’s attitude and use of music for those with dementia. A total of 214 participants completed the questionnaires, giving a response rate of 75·1%.

Results.  Most nursing staff held positive attitudes towards use of music for older people with dementia (mean = 84·89, range 23–115), but only 30·6% (n = 66) had used music for those with dementia in practice. The majority perceived that they had limited knowledge and skills about use of music (72·9%). Over half of the participants reported that they lacked resources and time to implement music therapy in practice.

Conclusions.  Nursing staff need more formal training to use music for those with dementia. Nursing staff can be the suitable personnel to learn easily and implement music therapy as a part of routine activity programmes for those with dementia.

Relevance to clinical practice.  Appropriately trained nursing staff in long-term care facilities who use music therapy may help improve the mental health of older people with dementia.

Wen-Li Lee

Papers

A preferred music listening intervention to reduce anxiety in older adults with dementia in nursing homes.

A fast edge-oriented algorithm for image interpolation

The effects of group music with movement intervention on agitated behaviours of institutionalized elders with dementia in Taiwan

Robot‐assisted therapy for improving social interactions and activity participation among institutionalized older adults: A pilot study

Exploring nursing staff's attitudes and use of music for older people with dementia in long-term care facilities.