Interventions Aimed at the Environment

Interventions in this category include modification of the physical environment, such as reducing clutter, addressing over- or understimulation (noise problems, visual surroundings, lighting), providing signage, and addressing safety issues, but may also be aimed at routines or activities that are a part of the environment [86]. This could include establishing set times for meals, appropriate bed times, and routines for delivery of care (time, location, and how), in addition to offering regularly scheduled activities such as socializing, exercise, and outings. Most of these types of intervention have not been tested in RCTs and a quantitative synthesis of data is not possible due to the diversity of the interventions. Interventions usually comprise more than one intervention category, for example, addressing both the family and environment, thus negating an elucidation of the specific contributions of each component. A qualitative synthesis of 63 studies found that 90 % of them reported positive results on diverse outcomes, including BPSD [129]. No studies tested whether interventions aimed at the environment could specifically address aggression, agitation, irritability, and hyperactivity.

The type of care unit can also be considered an intervention aimed at the environment. Kok et al. (2013) carried out a systematic review of studies comparing special care units (defined as units providing activities or designed specifically for residents with dementia) with non-special care units [130]. Residents in special care units displayed significantly more challenging behavior and agitation, but better psychosocial functioning and a higher quality of life. None of the studies were RCTs but several were categorized as quasi-experimental. Findings suggest that agitation and other behaviors may be better handled in special care units since quality of life was higher, but this remains speculative [130].

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