Reality orientation therapy benefits cognition in older people with dementia: A meta-analysis

Background/aims: To investigate the effect of reality orientation therapy on cognition, behavioral problems, and depressive symptoms in older people with dementia. Design: Meta-analysis of randomized controlled trials (RCTs). Data source: Various electronic databases were searched to select eligible articles, which included CINAHL, Embase, Pubmed, ProQuest, PsycINFO, the Cochrane Central Register of Controlled Trials, Google Scholar and Chinese electronic databases comprising Chinese Electronic Periodical Services and China Knowledge Resource Integrated. Review methods: Two reviewers independently extracted data and evaluated the methodological quality of the included articles. All analyses were performed using a random-effects model. Moderator analyses were conducted to identify the superior subgroup of intervention details that benefited from reality orientation therapy. Results: There was an overall random effect of reality orientation therapy of improving cognitive functions (n = 11, g = 0.39, 95% confidence interval [CI] = 0.25, 0.53); however, reality orientation therapy did not ameliorate behavioral problems (n = 5, g= −0.18, 95% CI= −0.36, 0.00) and depressive symptoms (n = 5, g= −0.17, 95% CI= −0.39, 0.05). A subgroup analysis revealed that studies of reality orientation therapy alone had a greater improvement in cognitive functions compared to those studies adopting reality orientation therapy combined with other types of techniques, but the difference in effect sizes between the two approaches was not significant (g = 0.51 vs. 0.35, p = 0.333). Conclusions: Reality orientation therapy can be considered routine care for the maintenance and improvement of cognitive functions in older populations with dementia. Health professionals and caregivers can be further educated and trained to regularly perform reality orientation therapy to improve the cognition of older people with dementia.