Dementia villages and other modern forms of residential care for persons with dementia: a systematic review
Systematic review
|Published
The purpose of this systematic review is to examine the effect of dementia villages and other types of modern residential care for people with dementia, compared with traditional residential care.
Key message
In recent years, dementia villages and other types of modern residential care have been developed, with the aim of providing people with dementia a better life. However, there is a lack of knowledge about the effect of these types of living compared to traditional residential care. The purpose of this systematic review is to examine the effect of dementia villages and other types of modern residential care for people with dementia, compared with traditional residential care.
We searched for randomized and non-randomized studies in research databases. We screened the references, extracted data and analysed studies that met our inclusion criteria. We included six non-randomised studies.
Our main findings show that compared with traditional residential care for persons with dementia,
it is:
- uncertain whether Green Care Farms (farming combined with dementia care) have an effect on ADL
- uncertain whether small-scale shared housing with confined outdoor areas have an effect on ADL, psychological and emotional functioning, depression, use of medication, falls, and dementia symptoms
- uncertain whether shared housing in urban flats have an effect on ADL and behavioral disorders
We have very low confidence in these results. The current evidence base is too limited to be certain of whether modern types of residential care have an effect on people with dementia compared with traditional residential care.
Summary
Introduction
Traditional nursing homes can have an institutional character and are not always appropriately designed for people with dementia. It is a political goal that future nursing homes and other residential care are built as small-scaled adapted housing units with a homely environment, distinct communal areas and few residents. In the last 20-30 years, a number of alternative care models have emerged for people with dementia. Common features of these new models are that they move away from traditional medical institutional care and emphasize person-centred care. The idea behind it is to enable "a life worth living" for people with dementia. These models facilitate that the residents have a normal life with as much autonomy as possible within safe surroundings. However, we lack summarized knowledge about the effects of dementia villages and other types of modern residential care for persons with dementia compared to traditional forms of residential care
Objective
The purpose of this systematic review is to examine the effect of dementia villages and other types of modern residential care for people with dementia, compared with traditional residential care.
Method
We conducted a systematic literature search in electronic databases in September 2021. We screened titles and abstracts to assess whether they met our inclusion criteria. We obtained references that we considered relevant in full text and made a final assessment of which studies to include. We evaluated the included studies’ risk of bias. Then we extracted predetermined data from the studies and analysed data when this was possible. When it was not possible to analyse data, we described the results narratively. We described the results from each study separately as it was not possible perform meta-analyses across studies.
We also evaluated our certainty in the results by assessing the certainty of the overall evidence by using the GRADE approach (Recommendations Assessment, Development and Evaluation).
Results
We included six studies (presented in seven publications), published between 2001 and 2017. The studies were conducted in Canada, the Netherlands, the USA, Japan and Germany. All studies were longitudinal non-randomized studies. The studies had 610 participants in total, and the sample size varied from 26 to 185 participants.
The interventions in the studies were different variations of small-scale housing for people with dementia compared with traditional residential care. The most important results and our certainty of the results are summarized in the table below.
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Summary table of effects of modern residential care for people with dementia compared with traditional residential care |
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Population: Persons with dementia; Intervention: Modern forms of residential care; Control: Traditional residential care |
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Outcomes |
Anticipated absolute effects* (95% CI) |
№ of participants |
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Risk with Modern forms of residential care compared with traditional forms of living |
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Small scale shared housing on Green Care Farms vs. traditional residential care |
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ADL after 6 months |
MD 0 |
56 |
⨁◯◯◯ |
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Small scaled shared housing vs. traditional residential care |
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ADL after 12 months |
MD 51.44 higher |
80 |
⨁◯◯◯ |
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Emotional function after 12 months |
MD 4.08 lower |
26 |
⨁◯◯◯ |
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Psychological function after 12 months |
MD 28.59 lower |
80 |
⨁◯◯◯ |
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Depression after 12 months |
MD 1.15 lower |
80 |
⨁◯◯◯ |
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Use of psychotropic medications after 12 months |
MD 0.19 lower |
80 |
⨁◯◯◯ |
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Falls after 12 months |
MD 1.79 lower |
80 |
⨁◯◯◯ |
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Symptoms common in dementia after 12 months |
MD 8.35 lower |
26 |
⨁◯◯◯ |
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Small scaled shared housing in urban flats vs. traditional residential care |
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ADL after 12 months |
MD 0.3 higher |
56 |
⨁◯◯◯ |
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Behavioural disorders after 12 months |
MD 7.4 lower |
56 |
⨁◯◯◯ |
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*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MD: mean difference; ADL: Activities of Daily Living
Explanations: a. Rated down two levels for risk of bias due to inadequate descriptions regarding measurement of outcomes and missing data b. Rated down one level for precision due to only a study, small sample size and wide confidence interval c. Rated down two levels for risk of bias due to differences in groups at baseline, large drop-out and inadequate descriptions of interventions and measurement of outcomes d. Rated down one level for precision due to only one study and small sample size e. Rated down two levels for risk of bias due to differences groups at baseline, inadequate descriptions regarding missing data and measurement of outcomes f. Rated down two levels for risk of bias due to large drop-out and inadequate descriptions regarding interventions and measurement of outcomes |
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Discussion
The results of this review show that it is uncertain whether modern types of residential care for persons with dementia have an effect on ADL, psychological and emotional function, depression, use of medications, falls, symptoms common in dementia and behavioral disorders compared with traditional residential care.
We did not identify other systematic reviews that have examined the effect of modern types of residential care for people with dementia compared with traditional residential care. However, we did identify a systematic review that examined the effects of various housing offers or elements of housing offers for people with dementia. Similarly, in this review, the results were uncertain, and the authors pointed out that the results should be interpreted with caution due to methodological limitations in the included studies.
The current scientific evidence is too scarce and the findings from our systematic review should be seen in connection with research on other outcomes such as quality of life, users' experiences and preferences as well as clinical experience.
We generally have very low confidence in the effect estimates in this review. This means that we have very low confidence that the effect estimates show the 'truth' or the 'real' effect of the interventions. Confidence in all the outcomes was downgraded due to a high risk of bias. Here the critical points were confounding factors, missing data and insufficient or lacking descriptions of interventions and how outcomes were measured. In addition, we downgraded for imprecise effect estimates and single studies with small samples.
There is a need for studies, of good methodological quality and with more participants that examine the effect of modern forms of residential care for people with dementia
Conclusion
The knowledge base is too scarce to determine whether modern forms of residential care have an effect in people with dementia compared to traditional residential care offers, based on the outcome measures focused on in this review.
