Barriers and Facilitators to Implementing Cognitive Stimulation and Reminiscence Therapy for Dementia in Care Homes: Systematic Review

Objectives

Psychosocial interventions play a vital role in addressing the complex needs of people with dementia in care homes. Cognitive stimulation and reminiscence therapy are recommended by the UK National Institute for Health and Care Excellence to support the cognition, independence, and wellbeing of people with dementia, and crucially, they can be delivered by care home staff or non-specialist interventionists. This review aims to explore factors that influence the implementation of cognitive stimulation and reminiscence therapy for people with dementia delivered by staff in care homes.

Methods

Ten electronic databases were searched between 2000 and April 2024. Two reviewers systematically appraised the studies for inclusion using pre-specified criteria and their quality using the Critical Appraisal Skills Programme (CASP) and Mixed Methods Appraisal Tool (MMAT) checklists. Data was analysed thematically using a deductive approach based on the updated Consolidated Framework for Implementation Research (CFIR), and findings were synthesised narratively.

Results

Nine studies were included; three focussed on reminiscence therapy, and six on cognitive stimulation. All interventions were delivered in care homes by care home staff. Many studies were excluded because a research team member delivered the intervention. Overall, the quality of the studies was low. Key facilitators to implementation were the availability of standardised manuals or resources, the adaptability of interventions, and staff training and support. Barriers included a lack of staff time and availability and a lack of perceived support from care home management. Most studies collected quantitative outcomes, and a minority collected qualitative information about implementation experiences and perceptions of the intervention. No studies collected qualitative data from people with dementia or their carers.

Conclusions

The review highlights the field's reliance on research staff to deliver interventions rather than training and involving care home staff in evaluating interventions. Additionally, there is a lack of qualitative data from people with dementia and their families regarding their views, preferences, and experiences related to participating in psychosocial interventions in care homes. There is a pressing need for high-quality evidence on the implementation of interventions for dementia, which involves collaboration, consultation and co-design with those who will deliver the intervention routinely and the people with dementia who will receive the intervention.

Trial Registration

CRD42022313337