ABSTRACT
References 228
There are frequent injunctions to try psychosocial methods first when treating challenging behaviour associated with dementia (e.g. Howard et al., 2001; Sink et al., 2005), mainly because meta-analyses over two decades show that psychotropic medications, in particular anti-psychotics, have modest effects and frequent side-effects (Schneider et al., 1990; Sink et al., 2005; Schneider et al., 2006). Unfortunately, the clinician seeking a ready-made psychosocial equivalent faces a problem. First, reviews of what are often presented as standardized approaches, such as Snoezelen or staff education, conclude that some show promise but that evidence for their effectiveness is weak (e.g. Landreville et al., 2006; O’Connor et al., 2009). Second, psychosocial interventions are not analogous to medication, and it is misleading to present them as such. Even methods which appear conceptually close (e.g. bright-light therapy) can only be effective in interaction with significant input from other psychosocial modalities, such as the dementia-specific interpersonal skills required to keep participants engaged.
