Can non-pharmacological interventions reduce hospital admissions in people with dementia? A systematic review

Background People with dementia who are admitted to hospital have worse outcomes than those without dementia. Identifying interventions that could reduce the risk of hospitalisation in people with dementia has the potential to positively impact on lives of people with dementia. This review aimed to investigate whether there are non-pharmacological interventions that successfully reduce hospitalisation risk, length of stay and mortality in people with dementia. Methods 7 electronic databases and trial registries were searched from inception to October 2018. We included randomised controlled trials that evaluated non-pharmacological interventions in out of hospital settings and targeted people with any type of dementia. All stages of the review process were performed by two reviewers. Risk of bias was assessed using the Cochrane Risk of Bias tool. We grouped studies based on intervention: care management, counselling/self-help, enhanced GP services or memory clinics, and physiotherapy or occupational therapy. Data were pooled within intervention categories using random effects meta-analysis. Results There was no evidence that any of the intervention categories were associated with reduced hospital admission or mortality. There was very weak evidence to suggest that care management interventions (mean difference, MD, -0.16, 95% CI -0.32, 0.01), physiotherapy/occupational therapy (MD -0.16, 95% CI -0.36, 0.03) and enhanced GP/memory clinics (MD -0.14, 95% CI -0.31, 0.03) were associated with small reductions in hospital stay. There was no evidence for an effect of counselling/self-help interventions on length of hospital stay. Conclusions Current evidence from randomised trials suggests no clear benefit or harm associated with any of interventions on risks of hospitalisation, duration of hospitalisation or death. Further research with the primary aim to reduce hospitalisation in people with dementia is required.