What is the evidence for physical interventions for people living with advanced dementia in the community? A meta-review
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White, Nicola
Feast, Alexandra
Evans, Catherine
Sampson, Elizabeth L.
Davies, Nathan
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2026
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BACKGROUND: Dementia is a major global cause of death, with cases projected to rise from 57.4 million in 2019 to 152.8 million by 2050. As the disease progresses, individuals experience growing frailty, complex health needs and multiple comorbidities, requiring comprehensive support to maintain quality of care. Non-pharmacological physical interventions, targeting either the physical body or immediate environment, may help address these needs, especially in advanced dementia nearing end of life. AIM: To map, appraise and synthesise evidence on the effectiveness of physical interventions for people with dementia nearing end of life. DESIGN: An umbrella review of systematic reviews on physical interventions, part of a broader palliative dementia care series. DATA SOURCES: MEDLINE, Epistemonikos and ASSIA were searched for systematic reviews from 1980 to May 2024 involving people with dementia, carers or staff in health and social care settings. Physical interventions were defined as non-pharmacological approaches focusing on the body or physical environment. RESULTS: From 6052 records, 13 reviews met the inclusion criteria. Interventions grouped into two categories: (1) nutrition and hydration (including enteral feeding) and (2) physical activities (including exercise, massage and approaches to reduce care resistance). Evidence quality was generally low, with no conclusive findings on effectiveness. Most interventions addressed well-being and function, with limited evidence for carer support, holistic assessment or medical management. CONCLUSION: Research has primarily targeted well-being and functional outcomes, leaving key gaps in carer support and holistic management, warranting further investigation. TRIAL REGISTRATION: PROSPERO CRD42020162887.
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BMJ supportive & palliative care