Impact of non-pharmacological nursing interventions onbehavioral and psychological symptoms of dementia (BPSD) ininstitutionalized older adults: A systematic review

Abstract

Behavioural and Psychological Symptoms of Dementia (BPSD), including agitation, aggression, anxiety, depression, wandering, apathy, sleep disturbances, hallucinations, and resistance to care, are common among older adults with dementia and represent a major challenge in institutional care. Pharmacological treatment may provide limited symptomatic benefit and is associated with important adverse effects in frail older adults. Consequently, non-pharmacological interventions are increasingly recommended as the first-line approach to BPSD management. To systematically evaluate the impact of non-pharmacological nursing interventions on BPSD among institutionalized older adults with dementia. The review included 26 eligible studies evaluating a range of non-pharmacological interventions in nursing homes, residential aged-care facilities, and long-term care institutions. Overall, individualized and person-centered interventions were associated with reductions in agitation, aggression, anxiety, depressive symptoms, and overall behavioral disturbance. Music therapy, reminiscence therapy, sensory stimulation, structured activities, and therapeutic communication also demonstrated beneficial effects on selected BPSD outcomes. Improvements were additionally reported in emotional well-being, communication, social engagement, sleep quality, and quality of life. Multi-component interventions appeared to provide broader benefits when tailored to residents' cognitive status, personal history, preferences, and behavioral triggers. Some studies also reported reductions in psychotropic medication use and restrictive behavioral management. However, substantial heterogeneity was observed in intervention duration, staff training, outcome measures, and institutional resources. Nonpharmacological nursing interventions represent a safe, person-centered, and clinically valuable approach to managing BPSD among institutionalized older adults. Individualized interventions integrated into routine nursing care appear particularly beneficial. Further high-quality studies are required to establish standardized protocols, long-term effectiveness, comparative effectiveness, and feasibility in low- and middle-income countries.