A Systematic Review of Quality Dementia Clinical Guidelines for the Development of WHO's Package of Interventions for Rehabilitation

Yun-Hee Jeon; Luisa Krein; Claire M C O'Connor; Loren Mowszowski; Shantel Duffy; Katrin Seeher; Alexandra Rauch

doi:10.1093/geront/gnac105

A Systematic Review of Quality Dementia Clinical Guidelines for the Development of WHO's Package of Interventions for Rehabilitation

Gerontologist. 2023 Oct 17;63(9):1536-1555. doi: 10.1093/geront/gnac105.

Authors

Yun-Hee Jeon¹, Luisa Krein¹, Claire M C O'Connor^{2

3}, Loren Mowszowski⁴, Shantel Duffy⁵, Katrin Seeher⁶, Alexandra Rauch⁷

Affiliations

¹ Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
² Centre for Positive Ageing, HammondCare, Sydney, Australia.
³ School of Population Health, University of New South Wales, Sydney, Australia.
⁴ Brain and Mind Centre & School of Psychology, The University of Sydney, Sydney, Australia.
⁵ School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
⁶ Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland.
⁷ Rehabilitation Programme, World Health Organization, Geneva, Switzerland.

Abstract

Background and objectives: As part of the WHO Rehabilitation 2030 call for action, the WHO Rehabilitation Programme is developing its Package of Interventions for Rehabilitation (PIR) to support ministries of health around the globe in integrating rehabilitation services into health systems. As a vital step for this PIR development, we conducted a systematic review of clinical practice guidelines (CPGs) for dementia to identify interventions for rehabilitation and related evidence.

Research design and methods: Following WHO Rehabilitation Programme and Cochrane Rehabilitation's methodology, quality CPGs published in English between January 2010 and March 2020 were identified using PubMed, Embase, CINAHL, PEDro, Google Scholar, guideline databases, and professional society websites. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation (II).

Results: Of the 22 CPGs that met the selection criteria, 6 satisfied the quality evaluation. Three hundred and thirty rehabilitation-related recommendations were identified, mostly concentrated in the areas of cognition, emotion, and carer support. There were many strong interventions, with moderate- to high-quality evidence that could be easily introduced in routine practice. However, major limitations were found both in the quality of evidence and scope, especially in areas such as education and vocation, community and social life, and lifestyle modifications.

Discussion and implications: Further rigorous research is needed to build quality evidence in dementia rehabilitation in general, and especially in neglected areas for rehabilitation. Future work should also focus on the development of CPGs for dementia rehabilitation. A multipronged approach is needed to achieve Universal Health Coverage for dementia rehabilitation.

Keywords: Dementia; Guidelines; Recommendations; Rehabilitation; Systematic review; Universal Health Coverage.

Publication types

Systematic Review

MeSH terms

Dementia*
Humans
World Health Organization

Grants and funding

001/WHO_/World Health Organization/International