Rapid Review of Interventions Designed to Enhance Personalised Care for People With Dementia When There Are Concerns About Reduced Awareness of Difficulties

Objectives

Awareness of difficulties varies in people with dementia. Low awareness, also termed anosognosia, has been implicated in carer stress and safety concerns, and can be a barrier to effective clinical communication. Little is known about how to manage situations arising from low awareness. This review looked for evidence of existing interventions to enhance care in situations regarding low awareness, and considered their utility, feasibility and acceptability when delivering personalised care.

Methods

We used systematic review methodology, adapted for a rapid timeline, searching five databases and grey literature sources. The review built on an earlier scoping review about measuring awareness in dementia. The protocol was registered on PROSPERO (CRD42024626367). Interventions were included if targeted at people with any dementia type in any setting, or dyads or informal carers, or clinicians. Interventions of any type were eligible where awareness had been measured and addressed, and quantitative outcome data were available. Risk of bias of included articles was assessed. The review is reported as a narrative synthesis.

Results

From the database search, 6042 articles were screened, with additional findings from grey literature. Seven articles were included, describing heterogenous interventions. Two interventions aimed to enhance awareness as the primary goal. No intervention was aimed at informal carers or clinicians, and none addressed specific everyday concerns arising from low awareness. Five non-pharmacological interventions used methods involving music, a garden, a cognitive programme, interview-based psychosocial approaches or staff training. These appeared generally acceptable to care recipients, with some feasibility of use, but with limited efficacy. Intervention goals regarding awareness were poorly defined. Outcomes on awareness were mixed in comparison with control groups, with slowing of decline at best. Some improvement in mood, quality of life and coping was observed. Two drug interventions showed a reduction in neuropsychiatric symptoms but limited utility regarding awareness. Available public guidance about awareness issues is relevant but lacks a clear evidence-base.

Conclusions

The review identified evidence gaps for suitable interventions for managing low awareness in dementia. Existing interventions have limited efficacy and application regarding awareness. There is scope for further intervention development in this area.