Outdoor activities, massage may be more effective for patients with dementia

For patients with dementia who have symptoms of aggression and agitation, interventions such as outdoor activities, massage, and touch therapy may be more effective treatments than medication in some cases, according to a new study published in Annals of Internal Medicine.

The systematic review and meta-analysis, led by researchers from St. Michael's Hospital in Toronto, Canada and the University of Calgary in Alberta, suggest outdoor activities were more clinically effective than anti-psychotic medication for treating physical aggression in patients with dementia. For patients with physical agitation, massage and touch therapy were more efficacious than usual care or caregiver support.

Dementia affects 50 million people worldwide and as many as three quarters of those living with the disease have reported neuropsychiatric symptoms including aggression, agitation and anxiety, according to Jennifer Watt, MD, PhD, a researcher at St. Michael's Hospital.

“Unfortunately, our understanding of the comparative efficacy of medication versus non-medicine interventions for treating psychiatric symptoms has been limited due to a lack of head-to-head randomized controlled trials of the two routes,” she said.

To address the gap, researchers led by Watt worked with 12 dementia care partners to select study outcomes based on commonly reported neuropsychiatric symptoms of the disease. They identified reports of improvement in aggression and agitation to be the main two outcomes to focus on in the analysis and review. Researchers analyzed 163 randomized controlled trials involving 23,143 people with dementia and the study of pharmacologic or non-pharmacologic interventions to treat aggression and agitation.

Though the study allows for the comparison of the two types of interventions, the researchers point out that neuropsychiatric symptoms of dementia do not have a one-size-fits-all solution. Further research will aim to understand the influence of individual patient characteristics on their response to interventions, Watt said. The researchers also note the need for an analysis of the differences in cost between pharmacologic and non-pharmacologic interventions to treat aggression and agitation in patients with dementia.

"This study shows us that multidisciplinary care is efficacious, and that is consistent with a person-centered approach to care," said Watt. "It points to evidence of the benefit of supporting multidisciplinary teams providing care to patients in the community and nursing home settings."