title: Nonpharmacological intervention for agitation in dementia: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The purpose of this study was to systematically review the literature regarding the effectiveness of nonpharmacological interventions for agitation in older adults with dementia.
  
  
  METHODS
  Seven electronic databases (to 2004) were searched, and randomized clinical trials employing nonpharmacologic interventions for agitation in dementia published in English or Korean were selected. In addition, the reference lists from relevant review articles and all eligible studies were searched to identify other trials. Interventions were categorized into seven types: sensory intervention, social contact, activities, environmental modification, caregiver training, combination therapy, and behavioral therapy. Studies were abstracted, and data were pooled by intervention category.
  
  
  RESULTS
  Fourteen studies (n = 586) were included. Sensory interventions were statistically significantly effective in reducing agitation (standardized mean difference: SMD -1.07; 95% confidence interval (CI) -1.76 to -0.38, p = 0.002), while social contact (SMD -0.19; CI -0.71 to 0.33), activities (SMD -0.20; CI -0.71 to 0.31), environmental modification (weighted mean difference: WMD 1.90; CI -2.82 to 6.62), caregiver training (SMD 0.21; CI -0.15 to 0.57), combination therapy (WMD 1.85; CI -1.78 to 5.48), and behavioral therapy interventions (SMD -0.27; CI -0.72 to 0.19) were not significantly effective in reducing agitation. These results were consistent among higher quality studies.
  
  
  CONCLUSIONS
  This systematic review indicated that among the seven types of nonpharmacological interventions available for agitation in older adults with dementia, only sensory interventions had efficacy in reducing agitation. More trials are needed to confirm this finding and future research should use more rigorous methods.
authors.affiliation: Department of Nursing, Kyungwon University, Seongnam-si, Gyeonggi-do 461-701, Korea. ehkong@kyungwon.ac.kr
authors.forename: Eun-Hi
authors.initials: EH
authors.lastname: Kong
authors.forename: Lois K
authors.initials: LK
authors.lastname: Evans
authors.forename: James P
authors.initials: JP
authors.lastname: Guevara
mesh_terms: D003704:Dementia / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011595:Psychomotor Agitation / Q000209:etiology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D026421:Sensory Art Therapies / Q000009:adverse effects*; D016896:Treatment Outcome