Barriers and facilitators to implementing non-pharmacological dementia therapies in residential aged care: a systematic review

Non-pharmacological therapies have demonstrated efficacy in alleviating dementia-related symptoms in residential aged care settings; however, their uptake remains limited. This systematic review aimed to identify the barriers and facilitators influencing the implementation of non-pharmacological therapies for people with dementia in residential aged care, with the goal of informing future research, practice and policy development. A systematic search was conducted across seven databases (PubMed, MEDLINE, PsycINFO, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, ProQuest) from January 2000 to March 2025. Studies were eligible for inclusion if they were published in English, involved participants aged 65 years and older with dementia residing in aged care facilities, and reported on implementation challenges or enablers related to non-pharmacological interventions. Three independent reviewers conducted screening, data extraction, and quality appraisal, with discrepancies resolved through consensus. The Mixed Methods Appraisal Tool was used to assess study quality. Data were synthesised using the Theoretical Domains Framework. Fifty-eight studies met inclusion criteria, representing 11 types of non-pharmacological therapies. The majority were qualitative in design (36/58; 62.1%). Music therapy (20/58; 34.5%) and recreation therapy (16/58; 27.6%) were the most studied. Key barriers and facilitators included staff availability (48/58; 82.8%), education and training (49/58; 84.5%), resource availability and cost (34/58; 58.6%), program usability (38/58; 65.5%), and organisational policy structures (34/58; 58.6%). There was no clear pattern in the type of barriers or facilitators reported by therapy type. Improving staff capacity, increasing access to training, ensuring resource availability, and designing flexible and user-friendly programs are critical to enhancing the successful adoption of non-pharmacological therapies in aged care. Addressing these factors may contribute to more sustainable and effective dementia care practices.