Strategies to improve continuity maintenance for people with dementia: a rapid realist review

Objectives: People with life-limiting diseases such as dementia are living longer. How to improve the quality of life of those living with dementia is an important challenge for society. Continuity maintenance in older adulthood is a psychosocial adaptation strategy by searching for preference and familiarity, making a sense of connection, and creating coherence. Continuity maintenance is a useful concept for effective dementia care, which could bring psychosocial benefits. This review investigates effective ways of continuity maintenance for people with dementia (PWD). Study design: A rapid realist review (RRR) of a comprehensive range of databases was conducted. Methods: Realist review methodology provides an explanatory analysis of what works for whom, in what circumstances, and is characterized by its focus on strategies/interventions, contexts, mechanisms, and outcomes. A literature search was conducted using four databases, and articles discussing potential interventions to maintain continuity in PWD were included. Data were extracted on key variables related to contextual factors, mechanisms, and outcomes. Results: Four key themes emerged: (1) maintaining personal identity, (2) maintaining social identity, (3) keeping a familiar environment, and (4) sustaining daily activities. It is hypothesized that these four factors combine and interact to maintain continuity and ultimately lead to psychosocial benefits. Conclusions: Maintenance of identity, environment, and activities is central to continuity for PWD. The resulting model and program theories respond to the need for a coherent approach to continuity maintenance. Using the foundations created by this RRR, nursing homes may psychosocially improve PWD through maintaining continuity.