How Can We Improve Personal Care Interactions to Reduce Care Refusals From People With Dementia? A Realist Synthesis.

The included evidence was very mixed: 71 sources ranged from effectiveness studies and observations to discussion pieces and websites, and 16 were rated low for rigour. The synthesis deliberately focused only on mechanisms in people with dementia, so it did not examine caregiver responses, training, staffing, time pressure or wider care cultures. The stakeholder interviews were small and homogeneous: 15 people, all White British, and only one was a person with dementia. The programme theories were not tested as an intervention, so they do not show that these strategies reduce refusals. The authors say the theories may be harder to apply as dementia progresses, especially for control, manageability, working together and engagement. Formal connection strategies may be less relevant for family caregivers because a relationship already exists.

The authors declare no conflicts of interest. Funding was from the National Institute for Health Research Applied Research Collaboration East of England.

Do not read the eight programme theories as proof that these strategies reduce care refusals. The synthesis built theories from sources and stakeholder interviews, many sources had low rigour, and the authors call for real-life evaluation.