People with dementia living in the community and their caregivers may benefit most from interventions with multiple components that are tailored to their needs

Dawson A, Bowes A, Kelly F, et al.  Evidence of what works to support and sustain care at home for people with dementia: A literature review with a systematic approach  BMC Geriatrics. 2015 May;15(59)

Review question

What is the current state of evidence surrounding care for people with dementia living in the community and their caregivers?

Background

With a global prevalence of dementia of almost 7%, millions of people are affected by this illness and the majority receive care while living at home.

Public policy has focused on reducing the use of institutionalized, long-term care and shifting the emphasis to care at home.

A better understanding of the current state of knowledge regarding the effectiveness of services to support people with dementia and their caregivers may alleviate the burden of this disease.

How the review was done

A detailed search of a number of electronic databases for studies published from 2002 to 2012 was conducted. Studies that included patients with dementia living and receiving care in the community or at home from a caregiver were included in the review.

A total of 1,763 studies were identified in searches and 131 were included in the review after assessment for eligibility.

This review was funded by Social Care and Social Work Improvement Scotland.

What the researchers found

Caregivers who provide care at home to people with dementia frequently encounter barriers to providing end-of-life and continence care. There is an underlying assumption that informal dementia caregivers are readily available, which is likely not the case.

Dementia prognosis is improved when services are tailored to individual needs and are provided in a timely manner. Nurses in the community may prove to be a significant source of support, but are currently under-used.

Due to the strain of caring for people with dementia, interventions including cognitive simulation, cognitive training and cognitive rehabilitation could result in improved outcomes for caregivers.

Conclusion

There are several issues with the current evidence base surrounding dementia care at home, including variations in the way outcomes are measured, and scientific rigour. Interventions with multiple components may prove most effective in providing support, but given the diversity of people with dementia, a greater understanding of the perspective of those receiving care and their caregivers is warranted. Involving these groups in research and policy development is the logical step forward.