Research paper Non-pharmacological interventions as a best practice strategy in people with dementia living in nursing homes. A systematic review E. Cabrera *, C. Sutcliffe, H. Verbeek, K. Saks, M. Soto-Martin, G. Meyer, H. Leino-Kilpi, S. Karlsson, A. Zabalegui On behalf of the RightTimePlaceCare Consortium 1 School of Health Sciences TecnoCampus, University Pompeu Fabra, Avda. Ernest Lluch 32, 08332 Mataro ´, Barcelona, Spain 1. Background Nursing homes (NH) provide medical attention to people who do not require hospitalization but cannot live alone. The majority of residents are elderly and evidence shows that two-thirds suffer from some type of dementia [1]. Dealing with the consequences of this disease: neuropsychiatric symptoms, functional difficulties, cognitive problems, deterioration of daily living activity skills, etc., European Geriatric Medicine xxx (2014) xxx–xxx A R T I C L E I N F O Article history: Received 3 April 2014 Accepted 2 June 2014 Available online xxx Keywords: Non-pharmacological interventions Best practice Dementia Nursing home Systematic review A B S T R A C T Background: Two-thirds of nursing home residents suffer from dementia and there is a need for effective and efficient interventions with meaningful outcomes for these individuals. This study aims to identify current best practices in non-pharmacological interventions in nursing homes. Methods: A systematic literature review was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration guideline. Studies and Randomized Controlled Trials (RCT) evaluating non-pharmacological interventions focused on improving the Quality of Care (QoC) and/or Quality of Life (QoL) of people with dementia (PwD) living in nursing homes were included. For individual study evaluation, the Cochrane Collaboration risk of bias assessment tool was used. Results: A total of 31 articles were included and five main categories emerged: psychosocial and educational, physical activity, sensorial therapies, staff-focused interventions and complex interven- tions. Psychosocial interventions were the most exhaustively studied and evaluated interventions. Few studies related to physical therapy were identified and they did not provide enough evidence of their effectiveness. Therapeutic touch was revealed to have positive effects on residents with dementia. Conclusion: Psychosocial interventions have been shown to have the potential to improve the QoL and QoC of people with dementia in nursing homes. Before implementation of the intervention, it is recommended that activities are adjusted according to residents’ characteristics and external factors controlled to achieve effectiveness and to structure a well-designed intervention. However, there is not enough evidence to support the effectiveness of non-pharmacological interventions in general. Further well-designed research is needed on non-pharmacological interventions in nursing facilities. ß 2014 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved. * Corresponding author. E-mail addresses: ecabrera@tecnocampus.cat (E. Cabrera), caroline.sutcliffe@manchester.ac.uk (C. Sutcliffe), h.verbeek@maastrichtuniversity.nl (H. Verbeek), Kai.Saks@kliinikum.ee (K. Saks), soto-martin.me@chu-toulouse.fr (M. Soto-Martin), Gabriele.Meyer@uni-wh.de (G. Meyer), Helena.leino-kilpi@utu.fi (H. Leino-Kilpi), Staffan.karlsson@med.lu.se (S. Karlsson), AZABALEG@clinic.ub.es (A. Zabalegui). 1 University of Witten/Herdecke (DE): Gabriele Meyer PhD, RN, professor (scientific coordinator, WP 1 leader), Astrid Stephan MScN, RN, Anna Renom Guiteras, geriatrician, Dirk Sauerland Dr.rer.pol., professor (WP 4 and 6 leader), Dr Ansgar Wu ¨ bker, Patrick Bremer dipl. oec. Lund University (SE): Ingalill Rahm Hallberg, professor (WP 2 leader); Ulla Melin Emilsson, professor; Staffan Karlsson, PhD, Christina Bokberg, MSc, Connie Lethin, MSc. Maastricht University (NL): Jan P.H. Hamers, PhD, RN, professor (WP 3 leader); Basema Afram, MSc; Hanneke C. Beerens, MSc, RN; Michel H.C. Bleijlevens, PhD, PT; Hilde Verbeek, PhD; Sandra M.G. Zwakhalen, PhD, RN; Dirk Ruwaard, MD, PhD, professor. University of Manchester (UK): David Challis, professor (WP5 leader); Caroline Sutcliffe MSc; Dr David Jolley; Sue Tucker, MSc, RN; Dr Ian Bowns; Brenda Roe, professor; Alistair Burns, professor. University of Tartu (EE): Kai Saks, MD, PhD, professor (WP 5 leader); Ene-Margit Tiit, PhD, professor; Jelena Leibur, MD, MBA; Katrin Raamat, MA; Angelika Armolik, MA; Teija Tuula Marjatta Toivari, MA, RN. Gerontoˆpole, University of Toulouse (FR): Dr Maria Soto; Agathe Milhet; Dr Sandrine Sourdet; Sophie Gillette; Bruno Vellas, professor. University of Turku (FI): Helena Leino-Kilpi, PhD, RN, professor; Jaana Koskenniemi, MNSc, RN, researcher; Riitta Suhonen, PhD, RN, professor; Matti Viitanen, MD, PhD, professor; Seija Arve, PhD, RN, docent; Minna Stolt, PhD, podiatrist; Maija Hupli, PhD, RN. – Fundacio ´ Privada Clinic per la Recerca Biomedica, Hospital Clinic of Barcelona (ES): Adelaida Zabalegui PhD, RN (WP 5 leader); Esther Cabrera PhD, RN (Tecnocampus Mataro ´ ), Montserrat Navarro PhD, RN Ester Risco MNSc, RN; Carme Alvira MScN, RN; Marta Farre MScN, RN; Susana Miguel MScN, RN. G Model EURGER-502; No. of Pages 17 Please cite this article in press as: Cabrera E, et al. Non-pharmacological interventions as a best practice strategy in people with dementia living in nursing homes. A systematic review. Eur Geriatr Med (2014), http://dx.doi.org/10.1016/j.eurger.2014.06.003 Available online at ScienceDirect www.sciencedirect.com http://dx.doi.org/10.1016/j.eurger.2014.06.003 1878-7649/ß 2014 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.