https://orcid.org/0000-0001-6240-0315
Figures
Abstract
Background
Adult Day care centres provide an important aspect of care provision through all phases of the dementia illness from diagnosis to the end of life (Dabelko HI 2008) supporting the well-being of both older people living with dementia and their care partners. Services within adult day care settings are designed to provide biopsychosocial health benefits to participants as well as care partner respite.
Objective
To examine research studies, literature reviews and grey literature and identify and map the literature on psychosocial interventions used in day care services for older people living with dementia and chart their use, evaluation and outcomes. The research review question is “what are the psychosocial interventions used in day care service for older people living with dementia?” Psychosocial interventions are important non-pharmacological interventions which support people’s wellbeing.
Methods
Inclusion/Exclusion criteria were identified and guided the search strategy. Participants were people aged 60 years and over living with dementia attending day care services. The use of psychosocial interventions for this cohort was the focus of the review. Databases were searched (Cochrane Reviews, CINAHL, Embase, Medline EBSCO, Medline Ovid, Medline PubMed, PsycINFO, Scopus, Open Grey, Lenus and WHO Global Index Medicus databases) using keywords/terms with Boolean operators from 2011 to 2023. Rayyan was used to extract and manage the data.
Results
The findings present a narrative and charting of the data from the 45 papers that met the review criteria, and this data is mapped onto the five objectives. Within this review, interventions were grouped into five broad types: nature (n = 6 papers), memory/cognitive (n = 11 papers), social (n = 17 papers), animal (n = 4 papers), or physical/sensory (n = 7 papers) based interventions.
Conclusions
This review has illustrated the wide variety in the types, range and facilitation of psychosocial interventions within adult day care services. This review highlights the potential benefits of these interventions. However, findings must be considered in the context that many were provided as brief intervention studies with little evidence of continuation after the study and further research is required given the complex and diverse range of interventions. Results will be of interest to practitioners planning to implement or evaluate psychosocial interventions used in day care services for older people living with dementia.
Citation: Tuohy D, Kingston L, Carey E, Graham M, Dore L, Doody O (2023) A scoping review on the psychosocial interventions used in day care service for people living with dementia. PLoS ONE 18(12): e0295507. https://doi.org/10.1371/journal.pone.0295507
Editor: Michael Thomas Lawless, Flinders University, AUSTRALIA
Received: February 17, 2023; Accepted: November 26, 2023; Published: December 11, 2023
Copyright: © 2023 Tuohy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Globally there are approximately 50 million people (majority of whom are older people) currently living with dementia, and this figure is set to double by 2030 and increase to 152 million by 2050 [1–3]. While dementia is not an normal part of ageing, it is recognised as affecting many older people. Dementia is an umbrella term used to describe a group of complex disorders characterized by progressive decline in cognitive functions [4]..Dementia, therefore is a global public health concern with the majority of diagnosis in people over 60 years. The majority of this population live in their own homes. The dementia illness trajectory can extend over several years. Traditionally, older people (people aged 60years and older) living with dementia were regarded as patients who were passive receivers of care. Care provision for people living with dementia has shifted from a paternalistic perspective, to a view where older people living with dementia are now regarded as being active users of healthcare services with diverse health care needs [5].. Consequently, a diverse range of interventions have been designed and implemented aiming to support the wellbeing of people with dementia and their care partners. Specifically, community based adult day care services provide an important aspect of care provision along the care continuum, supporting the well-being of both older people living with dementia and their caregivers [6].
In general, day centres or day care centres are known internationally to provide a range of educational, health, social and rehabilitative services for people with disabilities, across the lifespan. Such services can be governmental, voluntary or privately run organisations, with access though either personal choice of the individual or by referral. Eligibility conditions vary. More specifically, day care services with a diverse range of interventions have been designed and implemented to support the wellbeing of people living with dementia and their care partners. These adult day care services involve an integrated system delivered over a period of time to older persons living with dementia, supporting physical, emotional, mental, social, environmental and spiritual health and wellbeing of both the older person living with dementia and their care partner(s) across all phases of the dementia illness from diagnosis to the end of life [6].
Day care services are designed to provide biopsychosocial health benefits to participants as well as care partner respite. While there are various definitions of day care, all share common goals [7–9]. Essentially ‘day care center’ is a generic term describing community (building-based and green farms) services that offer a wide variety of programmes and services. Within this review, day care centers are defined as community based services that provide care and/or health-related services and/or activities specifically for older people irrelevant of whether these individuals reside in affiliated residential centres or at home and in which people can attend for a whole day or part of a day [7–9] The objectives of day care are to: improve quality of life through creating a meaningful day within a safe environment; focus on social interaction through a variety of activities organized individually or in groups; provide people with the support to continue living at home; provide respite for carers and for some older people, postpone the need for nursing home placement [8, 10, 11]. Research has shown the benefits of day care for older people living with dementia [12, 13]. and their families [14–17]. Currently evidence based interventions for dementia care comprise both pharmacological and non-pharmacological strategies and methods.
Increasingly there has been an emphasis on non-pharmacological interventions to support people living with dementia specifically psychosocial interventions. Olazarán et al. [18] describe a wide range of non-pharmacological therapies in Alzheimer’s disease including, cognitive therapies, reminiscence, music, therapeutic touch, light, physical exercise and development coping skills. McDermott et al. [19] outline psychosocial interventions as cognitive and physical as well as interventions which include social and psychological components. Social engagement and the social activities that are provided include psychosocial interventions. Psychosocial interventions can be defined as “interpersonal or informational activities, strategies or techniques that can target biological, behavioural, cognitive, emotional, interpersonal, social or environmental factors with the aim of improving an individual’s health functioning and mental well-being” [20] These are provided in a variety of health care centres including adult day care centres. Within the context of the diversity of psychosocial interventions being used in day care provision, it is important to identify the type, range and use of psychosocial interventions currently being used. This scoping review aims to do this. Specifically, the research review question is “what are the psychosocial interventions used in day care service for older people living with dementia?”
Methods
The six-stage framework by Arksey and O’Malley [21] and further developments by several authors [22–25] framed this review. Members of the research team represent expertise in nursing, older person, methodological and library/information. The review is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews [26]. In stage 1: we identified the research question, “what are the psychosocial interventions used in day care service for older people living with dementia?”. Discussions within the research team focused on the need to scope and review the existing literature with the aim of identifying the type, range and use of psychosocial interventions in the delivery of evidence based care in day care service for older people living with dementia. There are five objectives:
- What are the types and range of psychosocial interventions used in day care services?
- What is the reported use and facilitation of psychosocial interventions?
- What are the evaluation methods used for psychosocial interventions?
- What are the reported psychosocial interventions outcomes?
- What are the reported adaptations to psychosocial interventions?
Stage 2: searching for relevant studies was guided by the PCC format process where participants were people aged 60 years and over living with dementia (Participant), attending a day care centre (Concept) and receiving a psychosocial intervention (Context). Both databases and grey literature searches were performed in December 2021 and updated in February 2023 of the following: Cochrane Reviews, CINAHL, Embase, Medline EBSCO, Medline Ovid, Medline PubMed, PsycINFO, Scopus, using keywords/terms with Boolean operators (S1 File: search strategy). A grey literature search was undertaken, using the same search terms, inclusion and exclusion criteria in Open Grey, Lenus and WHO Global Index Medicus databases. All results were exported to endnote and duplicates removed and for screening and voting purposes exported to Rayyan. The search and screening process are reported using the PRISMA flow chart [27] (Fig 1: Prisma flow chart). Stage 3: selecting studies, after duplicates were removed the remaining independent screening was undertaken by two reviewers against the inclusion criteria presented in Table 1. Initial screening was by title and abstract and then at full text. Conflicts were resolved by involving a third reviewer with consensus reached. Stage 4: charting the data, data were extracted from all studies meeting the inclusion criteria into a predetermined data extraction table (S2 File: data extraction table (DET)), addressing details pertaining to authors, year and country, aim, design, type of intervention, use and facilitation of the intervention, outcomes and reported adaptations. Stage 5: collating, summarizing, and reporting the results. The extracted data were charted and reported descriptively with results mapped and presented in relation to the review questions. The results were presented in descriptive form using the sub-questions as headings and as appropriate tables and diagrams were used to illustrate the findings, these were enhanced by narrative text. In line with the objective of scoping reviews the results assisted in making recommendations. Stage 6: consultation, this is an optional step and not utilized in this review given the existing experience and expertise of the author group and difficulty in recruiting experts by experience when the project initially commenced during COVID-19.
Findings
The findings present a narrative and charting of the data from the 45 papers that met the review criteria and this data is mapped onto the five objectives outlined in step one of the framework [21] Within this review, interventions were grouped into five broad types: nature (n = 6 papers), memory/cognitive (n = 11 papers), social (n = 17 papers), animal (n = 4 papers), or physical/sensory (n = 7 papers) based interventions.
Types and range of psychosocial interventions used in day care service
Several different types of psychosocial interventions were identified as a single or combined interventions (Table 2). Nature based interventions representing the person’s experience or understanding of their own natural world included: green care farm [28, 29], farm based [30, 31] garden based [32] meaning in life in general [33].Memory/cognitive-based interventions related to reminiscence structured sessions [34, 35], life story interviews [36], life review programme[37], life story work [38], emotional therapy [39] and cognitive behavioural therapy [40, 41] Combined approaches included combined cognitive training, music and art therapy [42] combined environmental barriers and cognitive behavioural therapy [43] and combined reality orientation and cognitive behavioural therapies [44].
The social based interventions related to a single or range of activity combinations. Single social activities related to board games [45] comedy workshops [46] humanoid robot [47], adult care programme [14, 48, 49], technological group activity [50] and art activities [51] Combined social interventions were utilised in five studies [52–56] and within two of these studies occupational activities were incorporated [52, 55] In addition, the broad activity of music was identified and included song writing [57] listening to music to stimulate memory [58] ‘singing for the brain’ [59] and the development of a music application prototype to assist in human-computer interaction [60] Animal-based interventions related to the use of animal assist (canine) therapy [61–63] and an equine-assisted therapy intervention [64]. Physical/sensory-based interventions evident within this review included multisensory environments [65, 66], aromatherapy [67] dance activity [68], exercise programmes [69, 70]., while Rylatt [71] utilised a creative therapy exercise programme incorporating a combination of interventions (dance, drama, music, movement).
Use and facilitation of psychosocial interventions
Within the facilitation of psychosocial interventions several were ongoing while others are facilitated within a specific period/time limited specific programmes. Each study within the five broad types: nature, memory/cognitive, social, animal, or physical/sensory based interventions are presented in Table 3.
Participants attended a green care farm [28, 29, 33] and also a non-time limited programme with a similar structure for each day across all sites [31]. Whereas programmes focused on the use of GCFs to promote physical activities [30] and the use of a six-week programme of weekly gardening session [32]. Memory/cognitive-based interventions that were time limited ranged from five days [40], two weeks [37], four weeks [33, 34], six weeks [36], eight weeks [42] and 12 weeks [41]. Other programmes ran for over 12months [40, 44], over two years [38] or were open-ended [39]. essions ranged from one hour/day [39], three hours a day [40], one session per week [36], two/three sessions per week [34, 41, 43], four sessions per week [42], six/eight sessions per week [35], ten sessions per week [37] to thirty-three sessions per programme [43]. Facilitation was led by the primary researcher [36, 37] or a facilitator [34, 35, 38] but involved the inclusion of research assistants [36], staff [34, 37, 38] or another facilitator [35].
Social based interventions were individual sessions [55, 58, 60] or group sessions [52–54, 57, 59] The group programmes were open to whomever attended the centre on the day however, in one study six people participated in the original programme and ten in the modified programme [55]. Programmes ran for four weeks [46, 50], six weeks [51] eight weeks [56], three months [47] or appeared to be open-ended [45, 48]. Sessions ran for 45-60minutes [47, 56], one hour/day [51], two and half hours/day [48], two/three hours per week [46] or twice/week [50].
Two papers [14, 49] do not describe their use or facilitation while in other papers facilitation was supported by staff and therapists [57, 59]. Animal-based interventions were time limited ranging from one to two session per week over a period of four weeks [64], 12 weeks [61, 62] or 12 months [63]. Professional animal handlers were involved in all four programmes in conjunction with other facilitators [61–64]. Physical/sensory-based interventions were time limited ranging from four weeks [65] two months [67, 71], four months [68]. In contrast another review [66] reported time limits from 2 weeks to 12months while another two exercise programmes were not time limited [69, 70]. Sessions lasted up to 20 minutes [67], 30 minutes [65, 69–71] 40 minutes [66] to one hour/day [68].
Reported evaluation methods
A range of evaluations methods were used for the psychosocial interventions and can be grouped under into four categories 1) instrument/measurement measures (a broad spectrum of bio-psycho-social intervention measures) 2) exercise/functional measures, 3) qualitative measures and 4) activity measures and mapped under the five broad types: nature-based memory/cognitive, social, animal, or physical/sensory based interventions identified in this review (Table 4). Five papers did not report outcome measures [14, 34, 49, 57, 70]. Within the first category (instrument/measurement) fifty outcome measures were identified across 26 papers. The mini-mental state examination was reported in eight papers [28, 35, 36, 40, 41, 43, 47, 61]. the Clinical Dementia Rating Scale in five papers. [30, 40, 41, 61, 63] The Geriatric Depression Scale [35, 42, 44, 45] and the Cornell Scale for Depression in Dementia [35, 58, 66, 69] in four papers. The Cohen-Mansfield Agitation [58, 66], the Frontal Assessment Battery [35, 41] the Montreal Cognitive Assessment [45, 56], the Neuropsychiatric Inventory [35, 47] and the Quality of Life in Late-Stage Dementia Scale [47, 63], in two papers.
The remaining measure were reported in one paper each: Agitated Behavior Scale [65], Algase Scale [43], Alzheimer’s Disease Assessment Scale-Cognitive subscale [41], An ethogram catalogue [62], Apathy Inventory Scale [47], Apathy Scale for Institutionalized Patients with Dementia Nursing Home version [47], Barthel Index [28], Beck Anxiety Inventory [42], Behavior Intervention Monthly Flow Record [67], Behavioral Observation Recording [64], Berg Balance Score [61], Caregiver Exit Survey [65], Caregivers’ Survey [48], Clinical Global Impression-Improvement [66], Consortium to Establish a Registry for Alzheimer’s Disease ‐ Neuropsychological Battery [40], Daily Observation Scale [66], Digit Span task ‐ Finnish Wechsler Memory Scale [41], Emotional Satisfaction Index [39], Global Deterioration Scale [47], Instrumental Activities of Daily Living [48], Interview for Deterioration in Daily living in Dementia [28], Korean Dementia Screening Questionnaire-Cognition [42], Korean version ‐ Mini-Mental Status Examination [42], Lawton Scale of Activities of Daily Living, [51] Milan Overall Dementia Assessment, [44] Modified Nursing Home Behavior Problem Scale [64], Modified Philadelphia Geriatric Center Affect Rating Scale [64], Neuropsychiatric Inventory Nursing Home [66], Psychotic Behavior Assessment Record [66], Quality of Life in Alzheimer’s Disease [51], Quality of Life in Dementia Scale [61], Recreational Activities of Daily Living Scale [69], Salivary cortisol [64], Sedentary behaviour questionnaire [68], Seoul Neuropsychological Screening Battery [42], Seoul-Instrumental Activities of Daily Living [42], Severe Mini Mental State Examination [47], Short Form Health Survey [37], Social Functioning in Dementia Scale [51], the Clock Drawing Test [41] and the Trail Making Test [41].
Within the second category (exercise/functional) eight outcome measures were identified across four studies and all outcome measures were reported in one paper each; Accelerometer [68], Actigraphs [30], Barthel Index [28], Functional Ability Tests [69], Inclinometer [68], Interview for Deterioration in Daily living in Dementia [28], Non-exercise equation to calculate cardio-respiratory fitness [68] and the Timed Up and Go-test [30]. The third category (qualitative) highlighted five outcome measures across twenty papers. Interviews were reported in 11 papers [23, 28, 29, 31, 32, 45, 51, 54, 56, 57, 60]. Observations were reported in eight papers [32, 38, 52, 53, 55, 57, 60, 65].Video recording in five papers [36, 38, 46, 50, 60]. Reflective discussions in two papers [38, 44] and photograph in one paper [46].The final category (activity) highlighted three outcome measures across three papers. Outcome measures identified were an activity observation form [36], verbal fluency [56] and a self-designed tool [71].
Reported outcomes
A broad range of outcomes were identified within the papers reviewed. However, four papers identified no real difference [28, 41, 53, 67] and overall low to medium effect or maintenance post intervention was generally reported. These can be grouped under into four categories 1) increases in functioning, 2) social, 3) health and well-being and 4) enablement outcomes. Increases in functioning was reported in 16 papers across four elements: cognition [35, 37, 40, 42, 44, 45, 48, 51, 56] physical activity/ability, [30, 48, 63, 68–70] activities of daily living [42] and social skills [71].
Increases in social functioning was reported in 24 papers across eight elements. Connection/engaging with others was evident in 11 papers [32, 38, 43, 51, 54, 57, 60, 62, 65, 66, 71]. Increased communication was evident in seven papers. [36, 49, 50, 53, 56, 61, 72] Building relationships was evident in five papers [14, 31, 46, 54, 59]. Increased participation [29, 43, 48, 52] and increased social interaction [31, 32, 52, 53] were evident in four papers each. While increased enjoyment was evident in three papers [50, 57, 71] and increased group connection [57] and knowing the person [34] were evident in one paper each.
Health and well-being were reported in 17 papers across six elements and the main element was reduction in behaviours of concern [43, 47, 58, 63, 64, 66] Increased mood was evident in five papers [36, 42, 58, 59, 66].Three elements were all evident in three papers each: emotional well-being [38, 39, 70], increased well-being [33, 34, 63], quality of life [37, 61, 63]. The remaining element depression [35, 36] was evident in two papers.
Enablement was reported in seven papers across ten elements, two elements motivation [37, 57] and a sense of belonging [57, 60] were reported in two papers each. The remaining elements were all report in a single paper: a sense of accomplishment [57], increased agency [32], increased choice [52], collaborations [48], increased confidence [57], inclusion [59], a sense of freedom [32] and being self-conscious [57].
Reported adaptations
Of the studies reviewed 19 reported on adaptations or adjustments made when implementing the psychosocial interventions. This provided important contextual factors around implementation. Five studies within the nature-based interventions grouping are relevant here. Ibsen and Eiksen [31] recounted how all the interviews took place at the farms so that participants could better remember or relate to the day care setting. While Noone and Jenkin [32] reported that over the course of the gardening project, the researcher developed a relationship with each participant which enabled participants to feel comfortable communicating their level of willingness to participate in a particular activity. Chang et al. [36] described the focus of each reminiscence session being on a particular life phase with objects relevant to that period introduced for discussion and incorporating the use of records and interviews about older people’s early lives and interests. Gregory [34] adjusted the timings of the intervention depending on factors such as the participant’s ability to concentrate and communicate and the intrusion of others into the space. The participants’ words were recorded and shown to them to emphasise how effectively they had been able to communicate their life stories and in read back sessions the poet read the participants’ poem aloud. Finished poems were sent to GP and kept in patient files. Lin et al. [37] revised the life review programme to compress it into a short format that was administered in 10 successive sessions over 2 weeks.
Within the memory/cognitive-based interventions grouping two papers are relevant. Jung et al. [42] reported that the main activity stage comprised activities for strengthening memory and management function and for increasing attention, concentration, and space-time, perception, concept formation and reasoning, composition, language, and computational abilities. Help was provided if required by the participant and initially, an easy level programme was gradually adjusted to appropriate and slightly difficult levels executed to develop person interest, sense of achievement and confidence. The programme differentiates from existing chair-based exercises by including bilaterally asymmetric activities that involves the left side of the body moving differently to the right side of the body as well as activities requiring mirroring a partner to rhythmic music that evokes memories and reminiscence. Kallio et al. [41] tailored training according to the participants’ cognitive abilities and it was implemented either in small groups of two to four persons, or individually when needed due to difficulties in concentration, or lack of a training pair. The difficulty level was tailored during the sessions, but it was not automatic as in computerized training.
Six papers within the social-based interventions grouping six papers reported adaptations or contextual factors that determined how the intervention was adjusted. Gjernes [52] described the staff member initiating discussions and serving as the engine that made the network social. Typically, the staff member used strategies to involve every person in the knitting activity. The knitters were supported to remember and participate in telling their own stories. The staff member was both a potential helper and a member of the social network. The staff could provide knowledge and skills when needed or could assist the knitters in their problem-solving efforts. Lancioni et al. [55] described how in the modified program version the computer presented photos and videos, providing encouragements to talk as well as attention and guidance. In another [58] individualised music playlists were developed by asking caregivers about the participant’s favourite music or by playing different songs for participants to see their reactions. During the study, some participants listened to their favourite songs repeatedly, others listened to a variety of songs. Distraction was minimised by closing the door and ensuring the participant’s physical comfort. Peeters et al. [60] reported how the researcher used the analogy of a house with different rooms, in which buttons represent doors to move between rooms to explain the navigation through the different screens of music collections management functionality. Hattford-Letchfield [46] reported how a comedy workshops did not work to an exact script but allowed scenarios to develop based on the main theme. Experiential drama techniques were used to work with the issues identified by the participants. A selection of photographs was made into a ‘scrapbook’ of the project as a whole that could be used as a reminiscence tool after the project had finished. Cheung et al. [56] adapted the Play Intervention for Dementia and integrated elements of cognitive stimulation in six identified mind–body functional domains and followed the principles of cognitive stimulation. During the sessions, participants could exercise their creativity in a cheerful and respectful environment, without anyone judging their (dis-)ability or without pre-set rules.
Within the animal-based interventions grouping two papers reported adaptations [61, 62]. Both papers described how sessions were designed to follow a protocol but could be individually tailored to each participant based on the care workers’ knowledge of the participant. Hence, none of the animal assisted activities were mandatory and the sessions also included naturally occurring activities between the participants as well as between each participant and the dog. Within the physical/sensory-based interventions grouping two papers reported adaptations. Karania71 describes how this programme differentiates from existing chair-based exercises by including concurrent bilaterally asymmetric activities that involves the left side of the body moving differently to the right side of the body, as well as activities requiring mirroring a partner to the sound of rhythmic music that evokes memories and reminiscence. Chang, et al. [69] described a bespoke exercise programme designed as a series of exercise training interventions aimed at maintaining activities of daily living abilities with adaptations made to the comedy workshops and dance activities. Aguinaga and Marquez [68] reported modifying their dance intervention where participants wore an orange Velcro bracelet on their right wrist and a green Velcro bracelet on their left wrist to help them distinguish between moves to the left and right. The programme was adapted as needed by revising the dance moves in ways that still challenged participants physically and cognitively but did not overwhelm them or put their safety at risk.
Discussion
This scoping review illustrates the extent and range of psychosocial interventions being used in day care services. Forty-five papers were included in this review. Essentially, this review illustrated how there are many different types of psychosocial interventions and therefore these interventions belong to a ‘broad church’ in the sense of the myriad number and variety of psychosocial interventions being used. Crucially what they are all trying to do is to engage and support the person and enable them to connect and experience meaningful activities. The ability to connect is an important aspect of being ‘human’, as McCormack and McCance [72] have suggested that integral to being a person is being able to connect. This is especially so when a person is living with dementia as they experience challenges to their identity as people because of the effects of the dementia, therefore being able to connect with others, environment and self is key to being a person [72]. Personhood as a concept captures the uniqueness of personal identity and individuality of each person.
The psychosocial interventions described in this review illustrate how connections are made through and with the person through their physical body (sensory and motor), through time (immediate present and connecting with past), physical and psychological environment (space) and lastly through connecting with self and with others in a social world (relational). These connections of body, time, environment/ space and relationships resonate with the concept of lifeworld existentials of lived time (temporality), lived space (spatiality), lived body (corporeality), lived human relations (relationality) [73, 74]. The lived experiences of these connections are unique and individual to each person. Psychosocial interventions need to be provided from a person-centred holistic care perspective which supports the individual and their family [75, 76]. This will acknowledge the personhood and uniqueness of each individual and assist the person to self-actualise. There was strong evidence supporting the adaptation or modification of interventions as required based on individual client need in providing a person centred, flexible approach [31, 32, 34, 36, 37, 42, 46, 52, 55, 56, 58, 60–62, 69, 72]. Wyman and colleagues in a recent review reported key implementation factors that influence the impact of interventions, including, interventions tailored to stage of dementia, flexibility of delivery, participants engagement and carer supported [77].
This review illustrates the wide variety in the delivery and outcome aims of psychosocial interventions being provided, in so far as some are time limited, others open ended; some have very definite expected outcomes whereas others are less ‘directive’ or output driven. This may suggest that it is what is happening at this present time is the central or core focus of the intervention. People living with dementia can have cognitive and memory problems, (militating against remembering the psychosocial intervention once it is over) so it is the moment of connection that is important. The sense of connection was evident when creative therapy activities including dance, drama, music and movement were implemented and outcomes pointed to improved social skills and connection with those around them, among participants [71]. Meaningful connection with peers at the day care programme and connection with members of the community that alleviated some of the social and emotional isolation was reported when people living with dementia developed their life story project [38].
This review demonstrates how environment and space are important in helping people living with dementia connect. The use of the physical environment e.g. garden and green farms as psychosocial interventions [28–33] enable people living with dementia experience nature. Connecting with times past and past lives is evidenced by the use of psychosocial interventions such as reminiscence, life story and life review therapies [34–38] and as previously stated for some people, the present time is what matters as memory can be compromised.
The use of psychosocial interventions which enable connecting through bodily senses is facilitated by the use of psychosocial interventions which enable listening to and creating music [57–60], use of sight and hands to create art [51], tactile stimulation through multisensory therapy [65–67], animal therapy [61–64], robotic therapy [47] and exercise to engage the body to move [68–71]. Whilst not the focus of this review, Öhman et al. [78] emphasise the positive effect of physical exercise on cognition, this connection between mind and body may warrant further exploration within the context of psychosocial interventions. The ability to connect through relationships with others and with self are evidenced by the use of emotional/cognitive based psychosocial interventions which facilitate engagement of the mind [39–44] as well as the social interventions of music, art, multisensory, robotics, animals therapy as outline above as well as engagement in activities based psychosocial interventions [14, 45, 46, 48–50, 52–56]. This shows how psychosocial interventions can help connect the mind, body, temporal and spatial aspects of the person living with dementia.
Strengths and weaknesses of the review
To our knowledge, this is the first scoping review conducted to identify the psychosocial interventions used in day care service for people living with dementia. This review was conducted in compliance with a recognised review methodology framework [21–25]. The main strength of this review is its inclusivity through the broad definition of day care and psychosocial interventions and that the authors searched widely for evidence in diverse fields. The review was limited to 2011–2023 which ensured currency of the studies included. Despite searching eleven databases there are rather fewer studies on exercise and activity interventions than might be expected. Including these search terms or including non-English language studies may have yielded more studies with a focus on exercise and activity interventions. As the focus of a scoping review is on identifying, mapping and charting; critical appraisal and risk of bias assessments were not completed but it is acknowledged they are not a requirement for scoping reviews [79]. A further limitation of this review is the fact that the focus is on mapping and describing the evidence and the authors do not identify or discuss the efficacy of the reviewed interventions. Thereby the findings do not support the definitive evidence of the efficacy of these interventions however, they show potential and require further investigation.
Conclusion
This review aimed to identify the psychosocial interventions provided in day care services and it has illustrated the wide variety in the types, range and facilitation of these interventions. The review also highlights the need for and importance of supportive interventions that are person-centred and offer a sense of connection for people living with dementia. This review highlights the potential benefits of these interventions. However, findings must be considered in the context that many were provided as brief interventions with little evidence of longituidinal studies and further research is required given the complex and diverse range of interventions used in day care services for older people living with dementia and without, repeat measures post interventions to identify if short term benefits were sustained. Further research is required given the complex and diverse range of interventions identified. Nonetheless, results will be of interest to practitioners planning to implement or evaluate psychosocial interventions used in day care services for older people living with dementia.
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