Effectiveness of person-centered care on people with dementia: a systematic review and meta-analysis

Abstract

Background: Person-centered care is a holistic and integrative approach designed to maintain well-being and quality of life for people with dementia, and it includes the elements of care, the individual, the carers, and the family.

Aim: A systematic literature review and meta-analysis were undertaken to investigate the effectiveness of person-centered care for people with dementia.

Methods: Literature searches were undertaken using six databases including Medline, EMBASE, CINAHL, PsycINFO, Cochrane Database, and KoreaMed using the following keywords: cognition disorder, dementia, person-centered care, patient-centered care, client-centered care, relationship-centered care, and dementia care. The searches were limited to interventional studies written in English and Korean and included randomized controlled studies and noncontrolled studies for people with dementia living in any setting.

Results: Nineteen interventional studies, including 3,985 participants, were identified. Of these, 17 studies were from long-term care facilities and two studies were from homecare settings. The pooled data from randomized controlled studies favored person-centered care in reducing agitation, neuropsychiatric symptoms, and depression and improving the quality of life. Subgroup analysis identified greater effectiveness of person-centered care when implemented for people with less severe dementia. For agitation, short-term interventions had a greater effect (standardized mean difference [SMD]: -0.434; 95% conference interval [CI]: -0.701 to -0.166) than long-term interventions (SMD: -0.098; 95% CI: -0.190 to 0.007). Individualized activities resulted in a significantly greater beneficial effect than standard care (SMD: 0.513; 95% CI: -0.994 to -0.032). However, long-term, staff education, and cultural change interventions had a greater effect on improving the quality of life for people with dementia (SMD: 0.191; 95% CI: 0.079 to 0.302).

Conclusion: This systematic review and meta-analysis provided evidence for person-centered care in clinical practice for people with dementia. Person-centered care interventions were shown to reduce agitation, neuropsychiatric symptoms, and depression and to improve the quality of life. Person-centered care interventions can effectively reduce agitation for a short term using intensive and activity-based intervention. However, an educational strategy that promotes learning and skill development of internal care staff is needed to enhance patient's quality of life and to ensure the sustainability of the effects of behavioral problems. The feasibility and effectiveness of the intervention, the severity of patient disease, and intervention type and duration should be considered as part of an intervention design.

Keywords: dementia; meta-analysis; neuropsychiatric symptoms; patient-centered care; person-centered care; systematic review.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1

Study flow diagram. Note: Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–269, W64. Creative Commons license and disclaimer available from: http://creativecommons.org/licenses/by/4.0/legalcode"http://creativecommons.org/licenses/by/4.0/legalcode.

Figure 2

PCC intervention versus usual care, outcome: agitation. Notes: (A) Total effect. (B) subgroup analysis by intervention duration. Short-term =10 days to 3 months, long-term =>3 months (C) Subgroup analysis by intervention type. (D) Subgroup analysis by dementia severity in the study participants. Severe dementia group = mean MMSE >10 or majority population (>70%) diagnosed with moderate to severe dementia vs less severe dementia group = mean MMSE >10 or severe dementia patients comprised >30% of study participants. Abbreviations: MMSE, mini mental state exam; PCC, person-centered care; RCT, randomized controlled trial.

Figure 3

PCC intervention versus usual care, outcome: NPS. Abbreviations: NPS, neuropsychiatric symptoms; PCC, person-centered care; RCT, randomized controlled trial.

Figure 4

PCC intervention versus usual care, outcome: QoL. Notes: (A) Total effect. (B) subgroup analysis by intervention duration. Short-term =l0 days to 3 months, long-term =>3 months. (C) Subgroup analysis by intervention type. (D) Subgroup analysis by dementia severity in the study participants. Severe dementia group = mean MMSE >10 or majority population (>70%) diagnosed with moderate to severe dementia vs less severe dementia group. Mean MMSE >10 or severe dementia patients comprised >30% of study participants. Abbreviations: MMSE, mini mental state exam; PCC, person-centered care; QoL, quality of life; RCT, randomized controlled trial.

Figure 5

PCC intervention versus usual care, outcome: depression. Abbreviations: PCC, person-centered care; RCTs, randomized controlled trials.