title: Social-Professional Networks in Long-Term Care Settings With People With Dementia: An Approach to Better Care? A Systematic Review.
abstract: BACKGROUND
  Dementia is a syndrome associated with stigma and social isolation. Forty-two percent of people with dementia in the United States and almost 40% in the United Kingdom live in assisted living and residential care facilities. Up to 90% of residents with dementia experience behavioral and psychological symptoms of dementia (BPSD). Currently psychotropic drugs are often used to manage BPSD, despite the drugs' limited efficacy and adverse effects. Even though psychosocial approaches are as effective as medical ones without side effects, their uptake has been slow. Social networks that investigate the structure of relationships among residents and staff may represent an important resource to increase the uptake of psychosocial approaches and facilitate improvements in care.
  
  
  OBJECTIVE
  To conduct a systematic review of social network studies set in long-term care (LTC), including residents with dementia, and identify network factors influencing the care available to residents.
  
  
  METHODS
  Peer-reviewed articles across CINAHL, EMBASE, IBSS, Medline, PsychInfo, Scopus, and Web of Science were searched from January 1994 to December 2014 inclusive, using PRISMA guidelines. Studies included those examining social networks of residents or staff in LTC.
  
  
  RESULTS
  Nine articles from studies in the United States, Europe, Asia, and Australia met search criteria. Resident networks had few social connections. One study proposed that residents with high centrality be encouraged to welcome new residents and disseminate information. The high density in 2 staff network studies was associated with the cooperation needed to provide care to residents with dementia. Staff's boundary-spanning led to higher-status nurses becoming more involved in decision-making and problem-solving in one study. In another, the outcome was staff treating residents with more respect and actively caring for them.
  
  
  CONCLUSIONS
  These studies suggest interventions using a network approach may improve care services in LTC.
authors.affiliation: Dementia Collaborative Research Centre, School of Psychiatry, UNSW Australia, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia. Electronic address: j.mitchell@student.unsw.edu.au.
authors.forename: Janet I
authors.initials: JI
authors.lastname: Mitchell
authors.affiliation: Faculty of Medicine, John Walsh Centre for Rehabilitation Research, the University of Sydney, Australia.
authors.forename: Janet C
authors.initials: JC
authors.lastname: Long
authors.affiliation: Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Braithwaite
authors.affiliation: Dementia Collaborative Research Centre, School of Psychiatry, UNSW Australia, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, Australia.
authors.forename: Henry
authors.initials: H
authors.lastname: Brodaty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D011619:Psychotropic Drugs; D011785:Quality Assurance, Health Care; D012944:Social Support; D014481:United States
chemical_list: D011619:Psychotropic Drugs
keywords: BPSD; Dementia; long-term care; social networks