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Notepad A tool to keep notes and your questions to the health professional
Close the notepadYour options according to your priorities
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Light Therapy
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Learn more about the studies
Studies descriptionStudies and references
Livingston et al. 2014. Health Technol Assess 18 (39): 1-226.
Design and Interventions: Systematic review including 160 studies (physical activity: 1 RCT and 3 quasi-experimental studies; contact with an animal: 3 quasi-experimental studies; environmental approach: 4 quasi-experimental studies; cognitive approach: 3 RCTs; touch-based sensory interventions: 7 RCTs and 6 quasi-experimental studies; music therapy with a therapist: 7 RCTs, 2 quasi-experimental studies, and 1 control study; light therapy: 4 RCTs, 6 quasi-experimental studies; aromatherapy: 5 RCTs and 1 quasi-experimental study; other activites: 8 RCTs and 2 quasi-experimental studies); Participants: 50-year-old patients with dementia (all types and degrees) living in a care facility (physical activity: 193, contact with an animal: 26, environmental approach: 64, cognitive approach: 128, touch-based sensory interventions: 648, music therapy provided by a therapist according to a protocol: 403, light therapy: 444, aromatherapy: 276, other activities: 640).
- Temporary mild discomfort of their eyes (blurred vision, eye strain, glare, seeing spots, irritation)
- Infrequent and temporary hypomania, irritability, headache, or nausea
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Studies descriptionStudies and references
Forbes et al. 2015. Cochrane Database Syst Rev 2 : CD003946.
Design: Systematic review including 13 RCTs; Participants: 499 patients with mild to severe dementia; Intervention: light therapy (2500 to 10,000 lux) for 1-2 hours, morning and evening; Follow-up duration: 10-60 days.
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Touch therapy
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Studies description
Agitation is reduced for... 64%-77% of older people
23%-26% of older people
28%-54%
With Without Impact Studies and referencesLivingston et al. 2014. Health Technol Assess 18 (39): 1-226.
Design and Interventions: Systematic review including 160 studies (physical activity: 1 RCT and 3 quasi-experimental studies; contact with an animal: 3 quasi-experimental studies; environmental approach: 4 quasi-experimental studies; cognitive approach: 3 RCTs; touch-based sensory interventions: 7 RCTs and 6 quasi-experimental studies; music therapy with a therapist: 7 RCTs, 2 quasi-experimental studies, and 1 control study; light therapy: 4 RCTs, 6 quasi-experimental studies; aromatherapy: 5 RCTs and 1 quasi-experimental study; other activites: 8 RCTs and 2 quasi-experimental studies); Participants: 50-year-old patients with dementia (all types and degrees) living in a care facility (physical activity: 193, contact with an animal: 26, environmental approach: 64, cognitive approach: 128, touch-based sensory interventions: 648, music therapy provided by a therapist according to a protocol: 403, light therapy: 444, aromatherapy: 276, other activities: 640).
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Learn more about the studies
Studies descriptionStudies and references
Hansen et al. [2006]. Cochrane Database Syst Rev 4: CD004989.
Design: Systematic review including 2 RCTs; Participants: 110 institutionalized patients with varying degrees and types of dementia; Intervention: Relaxing music and hand massage for 10 minutes or verbal encouragement with touch therapy twice a day for one week.
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Reframing and Validation Therapy
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Studies descriptionStudies and references
Ministère de la Santé et des Services sociaux du Québec. 2014. Processus clinique visant le traitement des symptômes comportementaux et psychologiques de la démence (in French only)
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Learn more about the studies
Studies descriptionStudies and references
Livingston et al. 2014. Health Technol Assess 18 (39): 1-226.
Design and Interventions: Systematic review including 160 studies (physical activity: 1 RCT and 3 quasi-experimental studies; contact with an animal: 3 quasi-experimental studies; environmental approach: 4 quasi-experimental studies; cognitive approach: 3 RCTs; touch-based sensory interventions: 7 RCTs and 6 quasi-experimental studies; music therapy with a therapist: 7 RCTs, 2 quasi-experimental studies, and 1 control study; light therapy: 4 RCTs, 6 quasi-experimental studies; aromatherapy: 5 RCTs and 1 quasi-experimental study; other activites: 8 RCTs and 2 quasi-experimental studies); Participants: 50-year-old patients with dementia (all types and degrees) living in a care facility (physical activity: 193, contact with an animal: 26, environmental approach: 64, cognitive approach: 128, touch-based sensory interventions: 648, music therapy provided by a therapist according to a protocol: 403, light therapy: 444, aromatherapy: 276, other activities: 640).
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Learn more about the studies
Studies descriptionStudies and references
Orgeta et al. 2015. The British Journal of Psychiatry 207 (4): 293-298.
Design: Systematic review including 6 RCTs; Participants: 439 participants with light to moderate dementia; Intervention: cognitive/behavioural therapies (cognitive analytic therapy, behavioural therapies, problem-solving therapy), relaxation-inducing therapies (progressive muscle relaxation), psychodynamic therapies, interpersonal therapies, and counselling/coaching therapies.
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Studies descriptionStudies and references
Moniz-Cook et al. 2012. Cochrane Database Syst Rev 2 : CD006929.
Design: Case analysis; Participants: 5 patients with dementia marked by episodes of agitation and aggression;
Intervention: Systematic management of situations triggering episodes of agitation and aggression; Follow-up duration: 24 months. -
Simulated Social Contacts
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Studies description
A decrease in agitation is experienced by... 67-69% of older adults
31-46% of older adults
21-38%
With Without Impact Studies and referencesGarland et al. [2007]. Am J Geriatr Psychiatry 15 (6): 514-21.
Design: RCT; Participants: 30 institutionalized patients with moderate to severe dementia; Intervention: 15-minute audio recordings simulating a conversation with a family member and based on the patient's real-life experience; Duration: Once a day for 3 days in weeks 2, 3, and 4.
Camberg et al. [1999]. J Am Geriatr Soc 47(4): 446-52.
Design: Double-blind RCT; Participants: 54 institutionalized patients with severe dementia; Intervention: Personalized interactive recordings created by a member of the family; Duration: 17-30 days.
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Learn more about the studies
Studies descriptionStudies and references
Camberg et al. [1999]. J Am Geriatr Soc 47(4): 446-52.
Design: Double-blind RCT; Participants: 54 institutionalized patients with severe dementia; Intervention: Personalized interactive recordings created by a member of the family; Duration: 17-30 days.
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Learn more about the studies
Studies descriptionStudies and references
Kverno et al. [2009].International Psychogeriatrics 21 (5) : 825-843.
Design and Interventions: Systematic review, including 21 studies (emotion-focused interventions: 2 RCTs; simulated presence: 2 RCTs; environmental and behavioural approaches: 3 quasi- experimental studies; aromatherapy: 1 RCT; light therapy: 1 RCT and 1 quasi-experimental study; movement therapy: 1 RCT, 1 quasi- expéeimental study; music therapy: 3 RCTs; multi-sensory stimulation: 2 RCTs; cranial massage: 1 quasi-experimental study); Participants: participants with moderate to severe dementia (emotion-focused interventions: 237, simulated presence: 84, environmental and behavioural approaches: 171, aromatherapy: 164, light therapy: 33, movement therapy: 25, music therapy: 78, multi-sensory stimulation: 186, cranial massage: 11).
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Learn more about the studies
Studies descriptionStudies and references
Camberg et al. [1999]. J Am Geriatr Soc 47(4): 446-52.
Design: Double-blind RCT; Participants: 54 institutionalized patients with severe dementia; Intervention: Personalized interactive recordings created by a member of the family; Duration: 17-30 days.
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Contact with an Animal (Real or Stuffed)
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this option -
Learn more about the studies
Studies descriptionStudies and references
Livingston et al. 2014. Health Technol Assess 18 (39): 1-226.
Design and Interventions: Systematic review including 160 studies (physical activity: 1 RCT and 3 quasi-experimental studies; contact with an animal: 3 quasi-experimental studies; environmental approach: 4 quasi-experimental studies; cognitive approach: 3 RCTs; touch-based sensory interventions: 7 RCTs and 6 quasi-experimental studies; music therapy with a therapist: 7 RCTs, 2 quasi-experimental studies, and 1 control study; light therapy: 4 RCTs, 6 quasi-experimental studies; aromatherapy: 5 RCTs and 1 quasi-experimental study; other activites: 8 RCTs and 2 quasi-experimental studies); Participants: 50-year-old patients with dementia (all types and degrees) living in a care facility (physical activity: 193, contact with an animal: 26, environmental approach: 64, cognitive approach: 128, touch-based sensory interventions: 648, music therapy provided by a therapist according to a protocol: 403, light therapy: 444, aromatherapy: 276, other activities: 640).
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Learn more about the studies
Studies description
Aggression is reduced for... 65% of older adults
35% of older adults
30%
With Without Impact Studies and referencesKanamori et al. [2001]. Am J Alzheimers Dis Other Demen 16 (4) : 234-9.
Design: Quasi-experimental; Participants: 27 patients with moderate dementia being treated at a day centre; Intervention: therapy session with an animal once every two weeks; Duration: 11 weeks.
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Studies descriptionStudies and references
Kanamori et al. [2001]. Am J Alzheimers Dis Other Demen 16 (4) : 234-9.
Design: Quasi-experimental; Participants: 27 patients with moderate dementia being treated at a day centre; Intervention: therapy session with an animal once every two weeks; Duration: 11 weeks.
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Studies descriptionStudies and references
Filan et al. [2006]. International Psychogeriatrics 18 (04) : 597-611.
Design: Narrative review; Participants: 327 patients with dementia of varying degrees and severity living at home or in an institution; Intervention: Therapy with animals or substitutes (plush toy or robot); Duration: 3-12 weeks.
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Learn more about the studies
Studies descriptionStudies and references
Filan et al. [2006]. International Psychogeriatrics 18 (04) : 597-611.
Design: Narrative review; Participants: 327 patients with dementia of varying degrees and severity living at home or in an institution; Intervention: Therapy with animals or substitutes (plush toy or robot); Duration: 3-12 weeks.
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Physical Activity Tailored to Older Adults
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this option -
Learn more about the studies
Studies descriptionStudies and references
Livingston et al. 2014. Health Technol Assess 18 (39): 1-226.
Design and Interventions: Systematic review including 160 studies (physical activity: 1 RCT and 3 quasi-experimental studies; contact with an animal: 3 quasi-experimental studies; environmental approach: 4 quasi-experimental studies; cognitive approach: 3 RCTs; touch-based sensory interventions: 7 RCTs and 6 quasi-experimental studies; music therapy with a therapist: 7 RCTs, 2 quasi-experimental studies, and 1 control study; light therapy: 4 RCTs, 6 quasi-experimental studies; aromatherapy: 5 RCTs and 1 quasi-experimental study; other activites: 8 RCTs and 2 quasi-experimental studies); Participants: 50-year-old patients with dementia (all types and degrees) living in a care facility (physical activity: 193, contact with an animal: 26, environmental approach: 64, cognitive approach: 128, touch-based sensory interventions: 648, music therapy provided by a therapist according to a protocol: 403, light therapy: 444, aromatherapy: 276, other activities: 640).
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Learn more about the studies
Studies descriptionStudies and references
El-Khoury et al. [2013]. BMJ 2013, 347:f6234.
Design: Systematic review of 17 randomized controlled trials; Participants : 4,305 older people aged 60 years and more living at home; Intervention : Physical activity (e.g. Tai chi, balance exercices, strength exercices) with the aim of preventing falls. Follow-up duration : Varied from 6 to 30 months.
Liu, C.-j., & Latham, N. K. [2009]. Cochrane Database Syst Rev(3).
Design: Systematic review of 121 randomized controlled trials; Participants: 6,700 older people aged 60 years and more; Intervention: Progressive resistance strength training; Follow-up duration: Varied from the end of the intervention to 1 year.
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Learn more about the studies
Studies descriptionStudies and references
Rhyner et al. [2016]. Journal of aging and physical activity, 24(2), 234-236.
Design: Systematic review and meta-analysis of 41 randomized controlled trials; Participants: 2,780 older adults with or without a clinical diagnosis of depression; Intervention: Physical activity including tai chi, strength exercises, aerobics, yoga, aerobics and strength combo, and qigong, compared to any non-active control group; Follow-up duration: Tested immediately after the intervention.
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Music therapy
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this option -
Learn more about the studies
Studies description
A decrease in agitation is experienced by... 64-69% of older adults
31-36% of older adults
28-38%
With Without Impact Studies and referencesLivingston et al. 2014. Health Technol Assess 18 (39): 1-226.
Design and Interventions: Systematic review including 160 studies (physical activity: 1 RCT and 3 quasi-experimental studies; contact with an animal: 3 quasi-experimental studies; environmental approach: 4 quasi-experimental studies; cognitive approach: 3 RCTs; touch-based sensory interventions: 7 RCTs and 6 quasi-experimental studies; music therapy with a therapist: 7 RCTs, 2 quasi-experimental studies, and 1 control study; light therapy: 4 RCTs, 6 quasi-experimental studies; aromatherapy: 5 RCTs and 1 quasi-experimental study; other activites: 8 RCTs and 2 quasi-experimental studies); Participants: 50-year-old patients with dementia (all types and degrees) living in a care facility (physical activity: 193, contact with an animal: 26, environmental approach: 64, cognitive approach: 128, touch-based sensory interventions: 648, music therapy provided by a therapist according to a protocol: 403, light therapy: 444, aromatherapy: 276, other activities: 640).
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Coming Off Antipsychotic Medication
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Studies description
Improved survival rates after 3 years were experienced by... 53% of older adults
26% of older adults
27%
With Without Impact Studies and referencesBallard et al. [2009]. The Lancet Neurology 8 (2): 151-5.
Design: RCT; Participants: 165 institutionalized patients with Alzheimer's (hallucinations: 10% participants; delusions: 30%); Duration of medication withdrawal: 54 months.
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Studies description
After having been off antipsychotics, a relapse is experienced by... 60% of older adults
33% of older adults
27%
With Without Impact Studies and referencesDevanand et al. [2012]. N Engl J Med 367 (16): 1497-507.
Design: Double-blind RCT; Participants: 110 patients in institutions or living at home with light to severe dementia marked by episodes of agitation or psychosis; Average dose: 0.97 mg/d; Duration of medication withdrawal: 4-8 months.
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Learn more about the studies
Studies descriptionStudies and references
Declercq et al. [2013].Cochrane Database Syst Rev 3: CD007726.
Design: Systematic review including 9 RCTs; Participants: patients with varying degrees and types of dementia; certain studies included patients presenting psychotic symptoms, while others did not; Intervention: Withdrawal of antipsychotic treatment among patients with chronic use (≥3 months); Follow-up duration: short term (≤ 4 weeks) and long term (> 4 weeks).
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Indoor Gardening, Cooking
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this option -
Learn more about the studies
Studies description
A decrease in agitation is experienced by... 64-69% of older adults
31-36% of older adults
28-38%
With Without Impact Studies and referencesLivingston et al. 2014. Health Technol Assess 18 (39): 1-226.
Design and Interventions: Systematic review including 160 studies (physical activity: 1 RCT and 3 quasi-experimental studies; contact with an animal: 3 quasi-experimental studies; environmental approach: 4 quasi-experimental studies; cognitive approach: 3 RCTs; touch-based sensory interventions: 7 RCTs and 6 quasi-experimental studies; music therapy with a therapist: 7 RCTs, 2 quasi-experimental studies, and 1 control study; light therapy: 4 RCTs, 6 quasi-experimental studies; aromatherapy: 5 RCTs and 1 quasi-experimental study; other activites: 8 RCTs and 2 quasi-experimental studies); Participants: 50-year-old patients with dementia (all types and degrees) living in a care facility (physical activity: 193, contact with an animal: 26, environmental approach: 64, cognitive approach: 128, touch-based sensory interventions: 648, music therapy provided by a therapist according to a protocol: 403, light therapy: 444, aromatherapy: 276, other activities: 640).
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Aromatherapy
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this option -
Learn more about the studies
Studies descriptionStudies and references
Livingston et al. 2014. Health Technol Assess 18 (39): 1-226.
Design and Interventions: Systematic review including 160 studies (physical activity: 1 RCT and 3 quasi-experimental studies; contact with an animal: 3 quasi-experimental studies; environmental approach: 4 quasi-experimental studies; cognitive approach: 3 RCTs; touch-based sensory interventions: 7 RCTs and 6 quasi-experimental studies; music therapy with a therapist: 7 RCTs, 2 quasi-experimental studies, and 1 control study; light therapy: 4 RCTs, 6 quasi-experimental studies; aromatherapy: 5 RCTs and 1 quasi-experimental study; other activites: 8 RCTs and 2 quasi-experimental studies); Participants: 50-year-old patients with dementia (all types and degrees) living in a care facility (physical activity: 193, contact with an animal: 26, environmental approach: 64, cognitive approach: 128, touch-based sensory interventions: 648, music therapy provided by a therapist according to a protocol: 403, light therapy: 444, aromatherapy: 276, other activities: 640).
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Learn more about the studies
Studies descriptionStudies and references
Forrester et al. [2014]. Cochrane Database Syst Rev 2: CD003150.
Design: Systematic review including 7 RCTs; Participants: 428 patients with light to severe dementia; Intervention: Application of aromatic essential oils on hands, arms, or face for 1-2 minutes, twice a day, or diffusion of a drop of lavender oil during sleep; Follow-up duration: 3 to 12 weeks.
Light Therapy
Light therapy consists of exposure to daylight or to an artificial light that mimics natural outdoor light. The light is administered for a prescribed amount of time and, in some cases, at a specific time of day.
Current research shows that light therapy does not reduce agitation.
People who undergo light therapy can experience:
To be effective, the person generally needs to undergo light therapy daily. This takes time. You also have to buy the equipment.
Touch therapy
Massage therapy (hands and feet, acupressure), therapeutic touch, multi-sensory stimulation room.
For every 100 older people who receive touch-based sensory therapies, 28 to 54 experience a decrease in agitation.
Some older adults may feel uncomfortable with physical contact.
The older person may have to leave their home to receive this treatment (30-60 minutes, 1 to 3 times a week). Such services may also be available in the home.
You can expect to pay between $80 and $100 per massage therapy session. Some foundations or private insurers may cover these costs.
Reframing and Validation Therapy
Validation therapy is a method of communication that consists of recognizing and respecting the opinions of the other party (whether or not you agree with them).
Reframing consists of analyzing situations from a different angle by examining whether behavioural and psychological symptoms (agitation, aggression, and psychotic symptoms) pose a risk for the person or for others. Where the behaviour does not cause distress or a danger to the person or others, reframing consists of working to alter the perception of family and friends (and healthcare providers), as well as feelings of discomfort that the behavioural and psychological symptoms arouse in them.
The experts recommend reframing and validation therapy as a way to manage delusions, hallucinations, and illusions.
Current research shows that reframing and validation therapy does not significantly reduce agitation.
No adverse side effects are caused by reframing and validation therapy.
The level of qualification and experience of the professional can influence the effectiveness of this therapy.
Simulated Social Contacts
15 minutes audio recordings simulating conversations with members of the patient's family that are based on the patient's real-life experience.
For every 100 older adults who are exposed to simulated social contacts, between 21 and 38 experience a decrease in agitation.
Therapy using simulated social contacts is easy to administer and is generally appreciated by older adults.
Therapy using simulated social contacts presents a risk of aggravating certain symptoms, especially if the person's family relations are strained.
Therapy using simulated social contacts requires the patient to interact verbally. For some older adults with severe thinking or memory problems who are unable to communicate verbally, this therapy may not be feasible.
Contact with an Animal (Real or Stuffed)
In the studies reviewed, there was contact with an animal over the course of 1 to 9 sessions.
Current research shows that contact with a real or stuffed animal does not reduce symptoms of agitation.
For every 100 older adults who have contact with a real animal, 30 experience a decrease in aggression.
Current research shows that contact with real or stuffed animal does not reduce psychotic symptoms.
The older adult can injure the animal during episodes of physical agitation, and the animal can also injure the patient.
Contact with an animal is not appropriate for older adults who have allergies or are afraid of animals.
The older adult or their caregiver must be capable of caring for the animal.
Physical Activity Tailored to Older Adults
Physical activity programs can be adapted to older adults. They may include walking, water exercises, balance or flexibility exercises, and weight training. They can be done individually at home or with other people. The activities should produce a sensation of warmth, and make you breathe harder. You should be able to hold a conversation while exercising but be too short of breath to sing.
Current research shows that physical activity does not reduce symptoms of agitation.
Some older adults who take part in physical activity feel temporary muscle soreness after exercising. They can also experience muscle/bone problems such as tendinitis, arthritis, or fracture.
To achieve an impact, people may be physically active in various ways: from 20 minutes 3 times a week to 2 hours once a week, for a duration of 3 weeks to one year. Whatever the duration and frequency of the exercise, it takes time.
Music therapy
Music therapy is a type of group therapy provided by a therapist who follows a protocol. The protocol consists of evaluating the patient's physical, mental, relational, and emotional state, as well as their understanding of and interest in music. Depending on the person's needs, e.g., relaxation or cognitive stimulation, the therapist then propose an intervention plan that may include singing and simple musical instruments
For every 100 older adults who take part in music therapy, between 28 and 38 experience a decrease in agitation.
This intervention is feasible for older adults with advanced dementia who have difficulty communicating.
The older adult may have to travel to receive this intervention (10-60 minutes per session; 1-3 times/week).
Music therapy can cost between $60 and $100 per individual session. Group sessions are less costly.
Coming Off Antipsychotic Medication
The person is taken off antipsychotic medication under medical supervision.
Stopping antipsychotic treatment after 3 months of use allows the survival of 27 out of 100 seniors who have stopped for 3 years.
For every 100 older adults who come off antipsychotics after being successfully treated with them for 4 months, 27 experience a relapse (agitation or psychotic symptoms).
Older adults who come off their antipsychotic medication do not experience any more adverse side effects than those who continue their treatment.
Indoor Gardening, Cooking
For every 100 older adults who take part in gardening or cooking activities, individually or in a group, between 28 and 38 experience a decrease in agitation.
No adverse side effects are caused by gardening or cooking.
Aromatherapy
Application of aromatic essential oils on hands, arms, or face for 1-2 minutes, twice a day, or diffusion of a drop of lavender oil during sleep.
Research shows that aromatherapy does not reduce agitation.
Aromatherapy is easy to administer and is generally appreciated by older adults.
Aromatherapy does not cause any adverse side effects.
Aromatherapy should not be used by older adults who are unable to differentiate between scents.
© Laval University, 2017 - Conflicts of interest - Credits - References
Downgraded because of risk of bias, incoherence and imprecision of the estimate of effect.