Life In The Slower Lane

Here is the standardised PICO analysis for the seventeenth uploaded article:

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Full Title

What are best practices for involving family caregivers in interventions aimed at responsive behaviour stemming from unmet needs of people with dementia in nursing homes: a scoping review

Authors: Petra E M Tasseron-Dries, Hanneke J A Smaling, Miharu Nakanishi, Wilco P Achterberg, Jenny T van der Steen

Journal: BMJ Open, 2023; 13:e071804

DOI: 10.1136/bmjopen-2023-071804

Type of Study

Scoping review of 20 studies (qualitative, RCTs, quasi-experimental, mixed methods)

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PICO Summary

Population (P)

• People with dementia living in nursing homes, and their family caregivers
• Includes various stakeholders: family members, nursing staff, and interdisciplinary teams
• Studies conducted in the USA, UK, Australia, Canada, the Netherlands, and New Zealand

Intervention (I)

• Non-pharmacological interventions designed to reduce responsive behaviour stemming from unmet needs(e.g. pain, identity, social connection)
• Family caregiver involvement occurred through:
  • Activity planning and participation (e.g. Montessori-based care, Namaste Care)
  • Life story documentation
  • Shared decision-making about care and medications
  • Reminiscence therapy using technology (e.g. 3D objects, ambient devices)
  • Training in communication and understanding dementia

Comparison (C)

• No formal comparator group; synthesis focused on barriers and enablers to successful involvement
• Some studies contrasted usual care or staff-led care with enhanced family-involved interventions

Outcomes (O)

Person-centred outcomes:

• Improved resident quality of life through meaningful activities
• Strengthened emotional connection between residents and families
• Decreased use of psychotropic medications in some interventions
• Reduced responsive behaviours, such as aggression, screaming, and apathy

Process outcomes:

• Increased family engagement when involvement was structured, supported, and tailored
• Family caregivers preferred:
  • Clearly defined, practical activities
  • Reminiscence-based engagements
  • Active roles in shaping and planning care

Barriers (pp. 6–10):

• Poor communication with staff
• Lack of time, training, or organisational support
• Staff perceptions of demanding relatives
• Family caregiver distress, uncertainty, or lack of dementia knowledge
• Logistical limitations (distance, transport, COVID-19 restrictions)

Drivers of success:

• Training family caregivers in dementia communication and care principles
• Assigning staff to support family roles
• Leadership support and a person-centred care model
• Inclusion of family early in intervention design and implementation
• Shared meaningful activities that build emotional connection and empowerment 

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Findings Summary

This review provides a robust synthesis of how family caregivers can be meaningfully involved in care interventions targeting responsive behaviours in people with dementia. Best practices include shared planning of meaningful, personalised activities, respectful communication, structured training, and co-design of interventions. Success depends on organisational commitment, staff attitudes, and tailoring to family circumstances. Barriers include system-level constraints, caregiver stress, and unclear roles. The study reinforces a family-centred care model as a key approach for reducing distress and improving outcomes in dementia care.

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