The efficacy of complementary therapies for agitation among older people in residential care facilities : a systematic review

Background Agitation is recognised by aged care literature as the most common behavioural problem in residential aged care facilities. Complementary therapies are advocated by some as a solution to reduce the effect of agitation in older people and are becoming increasingly incorporating into nursing care. Complementary therapies in nursing management, is endorsed by the Australian Nurses and Midwifery Board for nurse initiation. Objectives The review objective was to discover which types of Complementary therapies are being implemented in RACFs for agitation management and which of these therapies where effective in reducing agitation. Inclusion criteria Types of participants Participants were people over the age of 65 years living permanently in a residential aged care facility and experiencing agitation, regardless of cognitive ability, gender or ethnicity and existing co-morbidities. Types of intervention(s)/phenomena of interest The types of complementary therapy interventions explored in this systematic review were Aromatherapy, Exercise, Massage, Music Therapy and Therapeutic Touch. Types of studies The systematic review considered randomised controlled trials of complementary therapy interventions that could be initiated by a nurse. Types of outcomes Outcomes measured were the frequency and/or severity of verbal, non-physical aggressive and physical aggressive agitation among the participants. Search strategy A comprehensive search strategy was developed for eleven electronic databases with dates ranging from January 2000 to September 2010. Searches included unpublished studies and the reference lists from identified papers. Only English language papers were considered due to a lack of interpreter facilities. Methodological quality An adapted version of the Joanna Briggs Institute quality appraisal checklist was used to assess the methodological quality of studies.. Appraisal was performed separately by two independent reviewers with any disagreement between appraisers settled by a third appraiser. Data collection Data was extracted using the standardised Joanna Briggs Institute Data Extraction Tool. Data synthesis Measurement tools reported different subcategories of agitated behaviours making data comparison difficult. A variety of complementary interventions made the comparing of this data inappropriate. Extracted data was unable to be synthesised in meta analysis, a narrative analysis of results was therefore more appropriate. Results The ten included randomised controlled trials reported all interventions effective in reducing non-physical and verbal agitation. Two interventions, aromatherapy and music therapy, showed significant effect in reducing physical aggressive agitation. Conclusions The results of this systematic review support the growing evidence that Complementary Therapies are effective in agitation management of older people in Residential Aged Care Facilities. Nurse initiation of complementary therapies will see timely and expedient management of agitation for older people. Therapies can be implemented with relative ease and low cost to the facility.