Non-Pharmacological Interventions for People With Dementia Who Live Alone: A Systematic Review

Abstract

Objectives: Approximately one third of people with dementia live on their own and they face an increased risk of unmet needs and loneliness. This systematic review aimed to identify and describe non-pharmacological interventions that have been evaluated for people with dementia living alone and to examine the effectiveness of these interventions.

Methods: Following PRISMA guidelines, six databases were systematically searched: MEDLINE, Embase, CINAHL, PsycINFO, Social Care online, and ClinicalTrials.gov. Studies that reported on the impact or experience of an intervention for people with dementia living alone in the community (not long-term care) and that had been published since 2000 were included in the review. No restrictions were applied in terms of study design or outcome measures. Study risk of bias was assessed, and a narrative approach was used to synthesize findings.

Results: Thirteen studies of 13 different interventions were included, grouped into five intervention categories: home-based dementia case/care management (n = 4), technology (n = 3), social (n = 3), cognitive (n = 2) and psychological (n = 1). There was one randomized controlled trial (RCT), and two economic evaluations that used data from RCTs. Most other studies were small-scale, and only two were evaluated to have low risk of bias. Most studies reported positive or mixed findings in terms of the intervention's impact on the person with dementia or aspects of feasibility. However, studies were heterogeneous in terms of intervention, study design, and outcomes.

Conclusions: This review of a limited body of research highlights the potential for interventions to support people with dementia who live alone. It also identifies key evidence gaps and the need for more robust and comparable research to better understand what works, why, for who, and how. Involving people with dementia who live alone in the design, implementation, and evaluation of these interventions will be crucial to ensure that their needs and preferences are met.

Keywords: dementia; interventions; living alone.

FIGURE 1

PRISMA flow diagram.

FIGURE 2

Summary of interventions, delivery agent and impact. Key: + (shaded grey) ‘positive’ impact (positive impact reported, either statistically significant improvement in all quantitative outcomes measures, or qualitatively assessed); − ‘no change’ (no evidence of significant change); +/− ‘mixed’ (findings were a mix of positive and no change). The superscript numbers correspond to the numbered references listed at the end of this article. DCM: Dementia Care Management; OT: Occupational Therapist.

FIGURE 3

Outcome measures used in the included studies. Key: + (shaded grey) ‘positive’ impact (statistically significant improvement in all quantitative outcomes measures); − ‘no change’ (no evidence of significant change); +/− ‘mixed’ (findings were a mix of positive and no change); ? ‘Unclear’. The superscript numbers correspond to the numbered references listed at the end of this article. ADL: Activities of Daily Living; ALONE: ALONE scale; AMQoL: Aging Mobility and Quality of Life Survey; Bayer ADL: Bayer Activities of Daily Living Scale; Cognistat: cognitive screening and assessment tool; DEMQOL: Dementia quality of life; EFS: Edmonton Frail Scale; EQ‐5D: Euroqol 5‐Dimension; GDS: Geriatric depression Scale; LSNS‐6: Lubben Social Network Scale; MMSE: Mini‐Mental State Examination; NPI: Neuropsychiatric Inventory; PHQ‐9: Patient Health Questionnaire 9 item; QoL‐AD: quality of life in Alzheimer's Disease; SF‐36: 36 item short form survey; WEBWBS: The Warwick‐Edinburgh Mental Wellbeing Scale.