Nonpharmacological nursing interventions for behavioural and psychological symptoms of dementia in acute and subacute settings: A systematic review

BackgroundBehavioural and psychological symptoms of dementia are a group of non-cognitive symptoms such as agitation, physical aggression, depression, sexual disinhibition and psychosis. Therapeutic approaches vary because of the multifactorial and complex symptomology. The researchers of this study aimed to systematically review the nonpharmacological interventions for BPSD used by nurses in acute and subacute hospital settings.DesignThe PRISMA guidelines guided this systematic review. The review was registered with PROSPERO (CRD42020184015).MethodThe databases Cumulative Index of Nursing and Allied Health Literature (CINAHL) complete, Medline complete, Excerpta Medica (Embase (R)) and PsycINFO published by the American Psychological Association (APA) were searched for studies published in English to October 2021. Quality appraisal was performed independently by three reviewers using the Critical Appraisal Skills Program tools. Data were synthesized using a narrative approach.ResultsTwo studies were identified that focused on interventions used by nurses; findings were positive for the use of nonpharmacological interventions to manage BPSD.ConclusionCurrent evidence suggests that nonpharmacological interventions are the best practices to manage BPSD. However, limited, and low-quality evidence suggests that further investigation is required to understand the factors contributing to the lack of use of nonpharmacological interventions by nurses in acute and subacute hospital settings. What is already known about this topic?Behavioural and psychological symptoms of dementia (BPSD) occur for approximately 95% of patients diagnosed with dementia and significantly impact individuals, families, communities and healthcare systems.Due to the limited benefits and potential harm of pharmacological interventions, nonpharmacological interventions are considered the first line of treatment to manage BPSD in clinical practice.Previous systematic reviews were limited to interventions implemented by a multidisciplinary team or nonpharmacological therapies conducted mainly in a residential or long-term care setting.What this paper adds?The existing body of evidence ascertains nonpharmacological interventions are effective in managing BPSD in patients with dementia.The authors of this review identified a gap in research for the nonpharmacological interventions used by nurses in acute and subacute hospital settings.The implications of this paper:This systematic review acknowledges the effectiveness of nonpharmacological interventions to reduce aggression and agitation in patients with dementia.It highlights two major gaps in the research: that there are very few studies conducted in hospital settings, and no studies report the use of nonpharmacological interventions by nurses on any symptoms of BPSD other than aggression in the hospital setting.