Supporting the Independence of Persons with Dementia
The Research Question
“What interventions are most effective in preventing or delaying the admission of people with dementia to long-term care?”
Supporting the independence of persons with dementia is a high-priority issue across the province. Our health system recognizes the importance of providing appropriate services for families who wish to have their loved ones “age in place” and/or those who hope to delay admissions into long-term care for family members with dementia for as long as possible. In 2014, the Newfoundland and Labrador Department of Health and Community Services and the four Regional Health Authorities asked the Contextualized Health Research Synthesis Program (CHRSP) to identify and review the best available research-based evidence on care options for people with mild to moderate levels of dementia. (At the time this topic was selected for study, the Department of Seniors, Wellness, and Social Development of the Government of Newfoundland and Labrador had not yet been created).
For this study, CHRSP assembled a project team that included officials from the four RHAs and the DHCS, the Executive Director of the Seniors’ Resource Centre of Newfoundland and Labrador, and a faculty member from the Western Regional School of Nursing. Dr. Neena Chappell, Canada Research Chair in Social Gerontology and Professor of Sociology at the University of Victoria, agreed to serve as our Subject Expert for the project.
Results in Brief
To give readers a sense of how much confidence they can place in the effectiveness of a given intervention, we have categorized the evidence for each intervention as:
- Promising – decision makers can be reasonably confident in the effectiveness of the intervention as a means for achieving the stated outcomes;
- Suggestive – the intervention may be worth trying, though administrators would be well-advised to evaluate its effectiveness carefully;
- Insufficient at present – readers should be cautioned against expecting that this intervention will, by itself, yield significant results in achieving stated outcomes.
For the interventions we studied, the evidence indicated the following:
- There is promising evidence for the effectiveness of psychoeducational caregiver supports. While face-to-face educational programs are most clearly effective, there is considerable evidence to support the use of educational and psychosocial interventions offered in combination, using a variety of delivery models.
- There is suggestive (partial or qualified) evidence to demonstrate the effectiveness of:
- dementia case management;
- exercise interventions as a means of reducing functional limitations, mobility problems, and falls among people with dementia; and
- interventions targeting performance of Activities of Daily Living (ADL), particularly when they involve face-to-face contact with health professionals.
- The evidence base is insufficient at present for the effectiveness of respite care, meditation (for caregivers) and interventions for preventing urinary incontinence.
The CHRSP Project Team
- Dr. Neena Chappell, Professor of Sociology University of Victoria (Subject Expert)
- Rosemarie Goodyear, President & CEO, Central Regional Health Authority (Health System Leader)
- Dr. Stephen Bornstein, Director, NL Centre for Applied Health Research (CHRSP Program Director)
- Rob Kean, Research Officer, NL Centre for Applied Health Research (CHRSP Project Coordinator)
- David Speed, Research Assistant, NL Centre for Applied Health Research (CHRSP Research Assistant)