Agitation is one of the most common symptoms in older people with dementia. It is typically defined as an inappropriate verbal, vocal, or motor activity unexplained by apparent conditions. It is hard establishing what one individual’s cause for agitation is. It may have, depending on the case, a neurological, physical, psychological, functional, interpersonal relation, environmental, or restraint explanation.
Most times, agitation is treated with medication and pharmacological interventions, despite them often having adverse effects on cognition and other domains. It is, therefore, not surprising that more attention has been given to non-pharmacological interventions. Sadly, results have varied widely, and as a result older people with agitation are still too often restrained either physically or chemically.
A team of scientist conducted an in-depth literature review because they wanted to find out what evidence there was for the efficacy of different non-pharmacological interventions targeting agitation. They were able to identify 7 different types of intervention:
- Sensory interventions: for example, aroma therapy, thermal baths, calming music, hand massage;
- Social contact: for example, simulated presence and pet therapy;
- Activities: for example, rocking chair therapy and therapeutic recreational activities;
- Environmental modification: for example, morning bright light therapy;
- Caregiver training: for example, behaviour management techniques and abilities-focused morning care;
- Combination therapy: for example, stimulation-retreat program;
- Behaviour therapy: for example, activities of daily living interventions and way finding intervention.
After carefully scanning the literature and selecting the appropriate studies, the researchers were able to say with certainty that only sensory interventions where somewhat effective for some people with agitation. They weren’t able to say anything conclusive regarding the efficacy of the other types on interventions, mainly due to problems in the research designs and methodologies of the studies they included in their literature review.
We agree with what the researchers advise, namely that much more research is needed to be able to assess which non-pharmacological interventions can be said to be, without a doubt, effective in managing agitation.
Kong, E., Lois, E. K., & Guevara, J. P., (2009), Nonpharmacological intervention for agitation in dementia: A systematic review and meta-analysis, in “Aging and Mental Health”, 13(4), pp. 512 – 520.