Effectiveness of Home-Based Activity Interventions on Behavioral and Psychological Symptoms of Dementia: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES: People living with dementia often face challenges related to behavioral and psychological symptoms (BPSD). Activity-based interventions have been proposed as a means to address these issues, but the overall effectiveness of such interventions implemented in home settings requires systematic evaluation. This study aimed to determine the effectiveness of home-based activity interventions for improving BPSD-related outcomes. RESEARCH DESIGN AND METHODS: A systematic literature search was performed across 6 English databases and 4 Chinese databases, covering articles published from database inception to December 2024. Randomized controlled trials published in English or Chinese that assessed the effects of home-based activity interventions on BPSD-related outcomes were included. Pooled effect sizes were calculated using random-effects meta-analysis models with standardized mean differences (SMDs) serving as the effect size metric. RESULTS: Thirteen eligible studies (published 2002-2024) were included, involving 8 types of home-based activity interventions. Meta-analysis demonstrated that these interventions significantly reduced overall BPSD-related outcomes with a small effect size (SMD=-0.27, 95% CI: -0.39 to -0.15, p < 0.05), and yielded symptom-specific benefits. Subgroup analyses revealed similar small efficacy for interventions delivered by professionals versus trained family caregivers, and for short-duration (≤12 weeks) versus long-duration (>12 weeks) programs. DISCUSSION AND IMPLICATIONS: Home-based activity interventions represent an effective non-pharmacological strategy for the management of BPSD. However, the limited number of included studies and inherent methodological weaknesses reduce the certainty of the evidence. Further high-quality research is warranted to strengthen the evidence base.