Natsumi Shimizu

OBJECTIVE: This umbrella review aimed to synthesize systematic reviews and meta-analyses to evaluate the effectiveness of non-pharmacological interventions (NPIs) on agitation, depression, anxiety, cognitive function, and quality of life in individuals living with dementia, and to examine the stability and methodological quality of the evidence base. METHODS: Systematic searches of MEDLINE (via EBSCOhost), PubMed, CINAHL, PsycINFO, and Web of Science databases were conducted from inception to February 2025. Systematic reviews and meta-analyses evaluating NPIs for older adults with dementia were included. Methodological quality was assessed using A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Evidence overlap was quantified using the corrected covered area (CCA), and effect estimates reported in the included reviews were synthesized narratively. RESULTS: Twelve systematic reviews, including 147 randomized controlled trials, were included. Methodological quality varied across reviews, and all reviews had at least one non-critical weakness. Review overlap was very slight (CCA = 1.8 %). Across reviews, NPIs were associated with small but consistent reductions in agitation (standardized mean difference ([SMD] -0.25, 95 %CI: -0.36 to -0.13), depression ([SMD] -0.20, 95 %CI: -0.29 to -0.11), and anxiety ([SMD] -0.21, 95 %CI:-0.34 to -0.09). A modest improvement was observed in cognitive function ([SMD] 0.22, 95 %CI:0.11 to 0.34 ), whereas no significant effect was found for quality of life ([SMD] 0.08, 95 %CI: -0.15 to 0.32). The most consistent benefits were reported for information and communication technology-based interventions, massage and touch therapies, and physical exercise. Evidence certainty was moderate for agitation, depression, and anxiety, but low or very low for cognitive function and quality of life. CONCLUSION: NPIs were associated with small but consistent improvements in agitation, depression, anxiety, and cognitive function among older adults with dementia. Although effect sizes were modest and evidence certainty varied across outcomes, the findings support NPIs as key components of person-centered dementia care. Further high-quality research is needed to clarify optimal intervention modalities, dosage, mechanisms of action, and implementation strategies across diverse care settings.

Background/Objective: Older patients with end-stage renal disease who receive dialysis often discontinue treatment before the end of their lives. However, the trajectory of family caregiving in this specific context remains under-researched. This study explored the experiences of family members caring for older patients with end-stage kidney disease (ESKD), from the introduction of dialysis to end-of-life care. Methods: This qualitative descriptive study included three family members caring for older patients with end-stage renal disease who were undergoing dialysis in Japan. Data were collected through semi-structured, one-on-one interviews and analyzed using inductive qualitative content analysis within a qualitative descriptive design. Results: The results identified seven categories regarding the family’s experience from dialysis initiation to end-of-life care: Key findings, particularly regarding the terminal phase, included ‘shock of dialysis treatment discontinuation’, ‘last moments shared with the patient’, ‘nostalgic memories of the patient over time, and ‘reflections on end-of-life care for the patient.’ Families described a process wherein the sudden need for proxy decision-making, often without prior discussion, was linked to feelings of regret. Conclusions: The findings describe the continuous experiences of family caregivers in the Japanese context. These exploratory insights suggest that the absence of early Advance Care Planning may contribute to caregiver distress during the withdrawal phase. The results highlight the need for culturally sensitive renal supportive care that fosters communication and understanding of patients’ wishes to mitigate the ethical burdens on families.