Both pharmacological and non-pharmacological therapies have been developed as options for responding to BPSD. The former however are problematic and adverse side effects are common and although the latter are considered to be a preferable option, there is conflicting evidence on their efficacy and practicality. This paper by Abraha et al. (2017) assesses the evidence supporting non-pharmacological interventions, by updating a previous systematic review from 2011, with the aim of providing a working compendium for the non-drug management of dementia, as part of the Optimal Evidence-Based Non-Drug Therapies in Older People project. Some 38 reviews were included, from which 142 primary studies were identified providing details on non-pharmacological interventions for BPSD. The interventions were classified into sensory stimulation interventions of which there were nine different types, e.g. massage therapy and light therapy, cognitive/emotion-oriented interventions of which there were four different types e.g. cognitive stimulation therapy and validation therapy, behavioural management techniques, multi-component interventions and other interventions including exercise therapy and animal-assisted therapy. Under each classification, the evidence for each type of intervention was reviewed. Among sensory simulation interventions, music therapy was found to the only convincingly effective intervention for reducing behavioural symptoms. Some behavioural management techniques were also found to be promising. However, the authors conclude that overall there is limited evidence supporting the efficacy of non-pharmacological interventions due to the sample size, methodological quality and variations of interventions and outcomes assessed.

Overall the study showed that CST delivered once weekly over 14 weeks had a positive impact on the person with dementia, their families and staff. Significant improvements were evidenced in participants’ subjective cognitive performance and in satisfaction with their performance. Significant improvements were also seen in facilitators’ ratings of participant engagement and confidence. The findings suggest a relationship between carer and participant wellbeing, and between carer wellbeing and their rating of participant cognitive function. The authors argue that it is time for the government to support the provision of CST across Ireland.

These residencies were initiated to create new artistic work that would promote greater understanding of the lived experience of persons with dementia and their experience of using services. Arts-based research methodologies were adopted and this approach is presented and the benefits explored. In each of the three residencies, the artists engaged with eight people with dementia, their family carers and hospital staff and the format that the residencies took is described. The paper summarises the results of the residencies under three headings: creation of original art works of high artistic quality; opportunities for increasing understanding and public awareness of dementia; creation of artworks that have an ongoing role as a tool for students to learn about dementia. The authors discuss the challenges and issues that arise when artists are brought into a medical setting, and also the contribution that arts-based research can make.

For some spirituality is associated with religion and a connection with God while for others it is connected with nature, art and music. Spirituality in dementia was also found to be embodied through relationship with others, fostering an ongoing sense of connection and occupation. However the person experiences their spirituality the literature indicates it is something that sustains the person in the face of dementia. The authors discuss the importance of both acknowledging and meeting spiritual needs for people with dementia while urging that no assumptions are made. Rather they argue these needs must be addressed at a personal level and as such they draw our attention to the importance of life story work. They also argue that the findings confirm the need for spiritual competency among health and social care practitioners.

Margaret began with improvised playing of the piano with the therapist but this developed over time to where she was able to co-compose songs with the therapist. There were improvements in Margaret's focus and attention and she took great joy in recognising herself and her story in the songs. Even when Margaret forgot she had written the songs, she could remember the words. Ahessy describes how after a cardiac arrest, Margaret became more subdued but the sessions continued to provide a way for her to emotionally connect with her evident fear of dying. He concludes that Margaret was supported in songwriting to connect with and express her emotions. She was able to sing, to improvise and to compose in collaboration. He suggests music therapy allowed her to experience herself in new ways and to strengthen her sense of self. Acknowledging the difficulties in quantifying the impact of therapies such as music therapy, Ahessy quotes Chavin (2002) who argues that "music is not a frill. It is something that we should simply consider adding into a dementia programme. It is essential to life."

(2017) wanted to investigate whether it was feasible to introduce the programme to usual care and to explore its impact on residents, families and staff. Acknowledging the limitations of the study which involved a very small number of participants, the authors suggest the study still offers valuable information both on the barriers such as additional demands on staff and the benefits; a measured improvement in behaviour and a perceived improvement in relationships between families and staff. They conclude that the programme can improve quality of care and that ideally resources would be made available to offer the programme to residents with dementia.

The core category to emerge was “becoming a person again”. Key to this is the understanding of psychosocial intervention as a mutual experience for staff and residents with dementia. Four conceptual stages are theorised around this category; balancing the influences; individualising status, striving to make the most of time; interpreting care. The authors suggest the theory offers new knowledge on how the use of a psychosocial intervention arises from a balancing of needs of residents with dementia and staff and that this model can support psychosocial intervention training and embedding in practice.

They identified four key factors related to quality of life (QOL): relationships, agency in life today, wellness perspective and sense of place. Within these factors it was the sense of connectedness or disconnectedness which influenced QOL. Further, where there was a sense of connection this related to happiness and a sense of disconnection related to sadness. The authors conclude that these findings offer the potential for further studies to identify ways to improve QOL for people with dementia, even in the face of cognitive decline.

Four examine perceptions of healthcare professions and one is a retrospective analysis of case notes pre and post doll therapy. The literature suggests that some people with dementia may benefit from the use of dolls with improvements shown in communication, interaction with others, dietary intake and general wellbeing. However it remains controversial with healthcare professionals’ attitudes identified as a barrier.

They describe the collaborative nature of the project which took 10 months to complete. The DVD provides an overview of hand massage and a demonstration. The authors argue that the DVD responds to new developments in learning and to the time pressures on professionals and carers, particularly in attending face to face training. Since its launch in 2012, hand massage has been introduced to residential settings for people with dementia and a number of workshops provided for health professionals and carers.

He highlights the value of such work for healthcare staff and relatives, as it allows them to view the person with dementia as more than their current diagnosis. For people with dementia it offers the opportunity to tell their story and can contribute to feelings of safety. McKinney (2017) concludes that any such work should begin early and that to be successful, must be embedded in a supportive culture.

Colomer & De Vries (2016) took a phenomenological approach to identify the perceptions and experiences of care workers in two nursing homes with a PCC policy. They found that most participants had not received training or education in PCC. They were vague and confused on questions examining their knowledge of PCC. Participants placed high value on training in practice, identifying team work as essential and highlighting the pressures of time and staffing constraints. The study found evidence of implicit knowledge of PCC but participants continued to describe aspects of good care within a task orientated framework. The authors acknowledge that the study is limited by size and recruitment from only 2 homes. However care assistant training in Ireland is standardised so they suggest it reflects issues across Ireland and a need to assess and most likely improve training.

 The programme was structured around a four-phase model: problem definition, accumulation of building blocks for intervention design, intervention design and validation.  The authors acknowledge that taking such a comprehensive approach is time consuming and labour intensive but argue that the nature of the programme gave staff ownership and enabled them to effectively use reminiscence in daily practice, improving their knowledge and ability to meet the psychosocial needs of residents.

(2003) which found that Cognitive Stimulation Therapy (CST) produced improvements in cognition and quality of life for people with dementia that compared favourably with trials of cholinesterase inhibitors. While this study used a smaller sample and a control group engaged in routine activities, findings reflected those of Spector et al. that CST has beneficial effects for people with dementia, evidenced by improved MMSE AND QoL-AD scores that fell just short of statistical significance. The authors acknowledge the limitations of the small sample size and also that the changes in MMSE and QoL-AD were not reflected in the ADAScog. 

 They document the initial enthusiasm that many creative projects are greeted with, only to fall in the face of obstacles such as a newer ‘fad’ promising better, cheaper results. They document the work to engage management and staff with a view to establishing a more durable project.  Staff reported positively on the programme but the single greatest obstacle was lack of time, as already reported in Cooney et al.’s study (2014). The authors suggest the project has highlighted the complexity of establishing enduring creative projects, even where they are regarded positively. 

 They found that music therapy had a positive impact on the behaviour of people with dementia but that there were methodological limitations in all thirteen studies reviewed.  Most of the studies were quantitative and the authors recommend larger sample sizes to allow for generalisation of results. They also suggest there is a need for more qualitative studies.

 However, the literature suggests that participative arts can make a positive contribution to those affected by dementia. They conclude the evidence must be strengthened but that studies should take account of the wider context, should be theoretically informed, include the views of people with dementia and incorporate economic analysis.

(2014) evaluated the effectiveness of a structured education-based reminiscence programme for people with dementia in long stay residential care settings in ROI. Effectiveness was measured in a two-group, single-blind clustered randomised trial, using self-rated quality of life as the primary outcome. The results on the effects of the intervention suggest that there was a positive but clinically non-significant improvement in the mean quality of life of the residents in the intervention group compared with the control group. However, the results of per-protocol analysis, which includes only units that followed protocol, indicates that there was a clinically and statistically significant effect of the intervention on quality of life of residents with those in the intervention groups experiencing a better improvement in quality of life compared to those in the control group.  

Staff felt that reminiscence allowed them to “see and know” the person behind the dementia and felt that it also allowed the person with dementia to view them as individuals, while residents perceived staff to be more interested in them as individuals.  The authors suggest this ‘revealing’ is not necessarily a result of the reminiscence but rather due to the resulting interaction and the shared bond that is created.  Family members welcomed staff getting to know their relative as an individual and the study also found that positive effects impacted on the wider group of residents.  Lack of time was the most significant barrier.

 They conclude that reminiscence is an effective psychosocial intervention and that developing the concept further would benefit from an operational definition.

 The protocol outlines a two-group, single blind cluster randomised trial conducted in long stay care settings.  The primary outcome is quality of life for residents, with secondary outcomes of agitation levels and depression in residents, and staff care burden.