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Nimmons D, Aker N, Burnand A, Jordan KP, Cooper C, Davies N, Manthorpe J, Chew-Graham CA, Kingstone T, Petersen I, Walters K. Clinical effectiveness of pharmacological and non-pharmacological treatments for the management of anxiety in community dwelling people living with dementia: A systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 157:105507. [PMID: 38097097 DOI: 10.1016/j.neubiorev.2023.105507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
People living with dementia commonly experience anxiety, which is often challenging to manage. We investigated the effectiveness of treatments for the management of anxiety in this population. We conducted a systematic review and meta-analysis of randomised controlled trials, and searched EMBASE, CINAHL, MEDLINE and PsycInfo. We estimated standardised mean differences at follow-up between treatments relative to control groups and pooled these across studies using random-effects models where feasible. Thirty-one studies were identified. Meta-analysis demonstrated non-pharmacological interventions were effective in reducing anxiety in people living with dementia, compared to care as usual or active controls. Specifically, music therapy (SMD-1.92(CI:-2.58,-1.25)), muscular approaches (SMD-0.65(CI:-1.02,-0.28)) and stimulating cognitive and physical activities (SMD-0.31(CI:-0.53,-0.09)). Pharmacological interventions with evidence of potential effectiveness included Ginkgo biloba, probiotics, olanzapine, loxapine and citalopram compared to placebo, olanzapine compared to bromazepam and buspirone and risperidone compared to haloperidol. Meta-analyses were not performed for pharmacological interventions due to studies' heterogeneity. This has practice implications when promoting the use of more non-pharmacological interventions to help reduce anxiety among people living with dementia.
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Affiliation(s)
- Danielle Nimmons
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK.
| | - Narin Aker
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | - Alice Burnand
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | | | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Nathan Davies
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | | | - Tom Kingstone
- School of Medicine, Keele University, Staffordshire, UK
| | - Irene Petersen
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
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Davies N, Kolodin V, Woodward A, Bhanu C, Jani Y, Manthorpe J, Orlu M, Samsi K, Burnand A, Vickerstaff V, West E, Wilcock J, Rait G. Models of care and the role of clinical pharmacists in UK primary care for older adults: A scoping review protocol. PLoS One 2023; 18:e0276471. [PMID: 37498969 PMCID: PMC10374084 DOI: 10.1371/journal.pone.0276471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 06/06/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION There has been global investment of new ways of working to support workforce pressures, including investment in clinical pharmacists working in primary care by the NHS in the England. Clinical pharmacists are well suited to support older adults who have multiple long-term conditions and are on multiple medications. It is important to establish an evidence base for the role of clinical pharmacists in supporting older adults in primary care, to inform strategic and research priorities. The aim of this scoping review is to identify, map and describe existing research and policy/guidance on the role of clinical pharmacists in primary care supporting older adults, and the models of care they provide. METHODS AND ANALYSIS A scoping review guided by the Joanne Briggs Institute methodology for scoping reviews, using a three-step strategy. We will search Medline, CINAHL, Scopus, EMBASE, Web of Science, PSYCHInfo, and Cochrane for English language articles, from 2015 -present day. Grey literature will be searched using Grey Matters guidelines, the Index of Grey Literature and Alternative Sources and Resources, and Google keyword searching. References of all included sources will be hand searched to identify further resources. Using the Population, Concept and Context framework for inclusion and exclusion criteria, articles will be independently screened by two reviewers. The inclusion and exclusion criteria will be refined after we become familiar with the search results, following the iterative nature of a scoping review. Data will be extracted using a data extraction tool using Microsoft Excel and presented using a narrative synthesis approach. ETHICS AND DISSEMINATION Ethical approval is not required for this review. Review findings will be disseminated in academic conferences and used to inform subsequent qualitative research. Findings will be published and shared with relevant local and national organisations.
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Affiliation(s)
- Nathan Davies
- Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, United Kingdom
| | - Vladimir Kolodin
- Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, United Kingdom
| | - Abi Woodward
- Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, United Kingdom
| | - Cini Bhanu
- Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, United Kingdom
| | - Yogini Jani
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jill Manthorpe
- NIHR Applied Research Collaborative (ARC) South London, King's College London, London, United Kingdom
- NIHR Policy Research Unit in Health & Social Care Workforce, King's College London, London, United Kingdom
| | - Mine Orlu
- Research Department of Pharmaceutics, UCL School of Pharmacy, University College London, London, United Kingdom
| | - Kritika Samsi
- NIHR Applied Research Collaborative (ARC) South London, King's College London, London, United Kingdom
- NIHR Policy Research Unit in Health & Social Care Workforce, King's College London, London, United Kingdom
| | - Alice Burnand
- Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, United Kingdom
- Department of Clinical and Movement Neurosciences, University College London, London, United Kingdom
| | - Victoria Vickerstaff
- Research Department of Primary Care and Population Health, PRIMENT Clinical Trials Unit, University College London, London, United Kingdom
| | - Emily West
- Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, United Kingdom
| | - Jane Wilcock
- Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, United Kingdom
| | - Greta Rait
- Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, United Kingdom
- Research Department of Primary Care and Population Health, PRIMENT Clinical Trials Unit, University College London, London, United Kingdom
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