A protocol for a systematic review of research on managing behavioural and psychological symptoms in dementia for community-dwelling older people

Background:Non-cognitive behavioural and psychological symptoms of dementia affect up to 90% of people with dementia at some point in the disease course and result in distress, increased carer burden, high service utilization and unwanted moves to care homes. Research has focused on long-term settings and has not considered people with dementia living at home and at different stages of the disease trajectory. The aim of this study is to review systematically the evidence concerning nonpharmacological strategies to minimise behavioural and psychological symptoms in community-dwelling older people with dementia.
Methods/design: We will employ a two stage co-design: 1) a systematic mapping of the broad evidence around behavioural and psychological symptoms followed by: 2) an in-depth systematic review of studies of non-pharmacological interventions for behavioural and psychological symptoms from the perspective of their impact on community-dwelling older people with dementia and their carers. The review will include published literature involving a wide range of electronic databases using sensitive and comprehensive searches and lateral searching including checking citations. We will produce a descriptive map of the studies by design and by the focus of interventions and apply further inclusion criteria, developed in conjunction with lay experts, to select studies for an in-depth systematic review which will include independent quality assessment and detailed data extraction by two reviewers. The review process will be integrated with stakeholder meetings and a multi-disciplinary expert advisory group to guide the review parameters and shape the research questions on
the management of behavioural and psychological symptoms in people with dementia. As studies are likely to be diverse in methodology and interventions we will conduct a narrative synthesis of the in-depth systematic review. If appropriate, we will pool studies in a metaanalysis.
We will explore review findings at both stages through focus groups and interviews with service providers, practitioners, people with dementia and carers.
Discussion: This integrated review in collaboration with key stakeholders will synthesise research evidence to identify appropriate interventions for effective management of behavioural and psychological symptoms that supports people with dementia living at home and their carers, and which reflects their priorities. It will make recommendations for research and practice.