title: A best-evidence review of intervention studies for minimizing resistance-to-care behaviours for older adults with dementia in nursing homes.
abstract: OBJECTIVE
  To conduct a best-evidence review of non-pharmacological interventions for resistance-to-care behaviours of nursing home residents with dementia in a personal-care context.
  
  
  BACKGROUND
  Resistance to care is a major source of staff burnout in nursing homes and it is also a safety issue for the staff.
  
  
  METHODS
  Best-evidence review.
  
  
  METHODS
  We searched for non-pharmacological intervention studies published from 1990-2012, written in English.
  
  
  METHODS
  The search identified 19 intervention studies that examined the effects of interventions to reduce the resistance-to-care behaviours of nursing home residents with dementia in a personal-care context. These 19 papers met the quality assessment requirements of the critical appraisal criteria for experimental studies, which were published by the Joanna Briggs Institute.
  
  
  RESULTS
  Only three studies were RCTs and the rest were quasi-experimental. The sample size ranged from 7-127. Nine music interventions, such as pre-recorded music played to a group or playing a resident's preferred music, during his or her personal care, resulted in significant reductions in resistance-to-care behaviours. Resistance-to-care behaviours also were significantly reduced in three of four bathing interventions that focused on person-centred care. In the ability-focused interventions, only two out of five studies reported significant reductions in resistance-to-care behaviours.
  
  
  CONCLUSIONS
  Non-pharmacological interventions are options to consider to reduce resistance-to-care behaviours in older people with dementia, even though the evidence level is low, given the lack of alternatives. More randomized controlled trials are recommended to confirm the effects of non-pharmacological interventions during personal care.
authors.affiliation: Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka University, Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Konno
authors.forename: Hee Sun
authors.initials: HS
authors.lastname: Kang
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Makimoto
mesh_terms: D000368:Aged; D003704:Dementia / Q000451:nursing* / Q000523:psychology*; D055318:Evidence-Based Nursing; D006801:Humans; D009735:Nursing Homes; D010342:Patient Acceptance of Health Care
keywords: dementia; interventions; literature review; nursing; nursing home; older adults; resistance-to-care; systematic review