A best-evidence review of intervention studies for minimizing resistance-to-care behaviours for older adults with dementia in nursing homes

J Adv Nurs. 2014 Oct;70(10):2167-80. doi: 10.1111/jan.12432. Epub 2014 Apr 16.


Aim: To conduct a best-evidence review of non-pharmacological interventions for resistance-to-care behaviours of nursing home residents with dementia in a personal-care context.

Background: Resistance to care is a major source of staff burnout in nursing homes and it is also a safety issue for the staff.

Design: Best-evidence review.

Data sources: We searched for non-pharmacological intervention studies published from 1990-2012, written in English.

Review methods: The search identified 19 intervention studies that examined the effects of interventions to reduce the resistance-to-care behaviours of nursing home residents with dementia in a personal-care context. These 19 papers met the quality assessment requirements of the critical appraisal criteria for experimental studies, which were published by the Joanna Briggs Institute.

Results: Only three studies were RCTs and the rest were quasi-experimental. The sample size ranged from 7-127. Nine music interventions, such as pre-recorded music played to a group or playing a resident's preferred music, during his or her personal care, resulted in significant reductions in resistance-to-care behaviours. Resistance-to-care behaviours also were significantly reduced in three of four bathing interventions that focused on person-centred care. In the ability-focused interventions, only two out of five studies reported significant reductions in resistance-to-care behaviours.

Conclusion: Non-pharmacological interventions are options to consider to reduce resistance-to-care behaviours in older people with dementia, even though the evidence level is low, given the lack of alternatives. More randomized controlled trials are recommended to confirm the effects of non-pharmacological interventions during personal care.

Keywords: dementia; interventions; literature review; nursing; nursing home; older adults; resistance-to-care; systematic review.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Aged
  • Dementia / nursing*
  • Dementia / psychology*
  • Evidence-Based Nursing*
  • Humans
  • Nursing Homes*
  • Patient Acceptance of Health Care*