Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic review.
BACKGROUND
Wandering occurs in 15-60% of people with dementia. Psychosocial interventions rather than pharmacological methods are recommended, but evidence for their effectiveness is limited and there are ethical concerns associated with some non-pharmacological approaches, such as electronic tracking devices.


OBJECTIVE
To determine the clinical and cost effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia.


METHODS
A systematic review to evaluate effectiveness of the interventions and to assess acceptability and ethical issues associated with their use. The search and review strategy, data extraction and analysis followed recommended guidance. Papers of relevance to effectiveness, acceptability and ethical issues were sought.


RESULTS
(i) Clinical effectiveness. Eleven studies, including eight randomised controlled trials, of a variety of interventions, met the inclusion criteria. There was no robust evidence to recommend any intervention, although there was some weak evidence for exercise. No relevant studies to determine cost effectiveness met the inclusion criteria. (ii) Acceptability/ethical issues. None of the acceptability papers reported directly the views of people with dementia. Exercise and music therapy were the most acceptable interventions and raised no ethical concerns. Tracking and tagging devices were acceptable to carers but generated considerable ethical debate. Physical restraints were considered unacceptable.


CONCLUSIONS
In order to reduce unsafe wandering high quality research is needed to determine the effectiveness of non-pharmacological interventions that are practically and ethically acceptable to users. It is important to establish the views of people with dementia on the acceptability of such interventions prior to evaluating their effectiveness through complex randomised controlled trials.
Robinson
L
L
Centre for Health Services Research, University of Newcastle, School of Population & Health Sciences, Newcastle upon Tyne, UK. a.l.robinson@ncl.ac.uk
Hutchings
D
D
Dickinson
H O
HO
Corner
L
L
Beyer
F
F
Finch
T
T
Hughes
J
J
Vanoli
A
A
Ballard
C
C
Bond
J
J
D000368:Aged; D003221:Confusion / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003704:Dementia / Q000523:psychology / Q000534:rehabilitation*; D019317:Evidence-Based Medicine; D006801:Humans; D010342:Patient Acceptance of Health Care; D017751:Safety Management / Q000191:economics / Q000941:ethics / Q000379:methods; D016896:Treatment Outcome; D016138:Walking