A critique of research on the use of activities with persons with Alzheimer's disease: a systematic literature review.

TOPIC The topic of this paper concerns the use of therapeutic activities with persons with Alzheimer's disease (AD). PURPOSE The purpose is to present a critique of the research on these activities, with an emphasis on methodology. ORGANIZING CONSTRUCT AND SCOPE: Nursing literature identifies a number of purposes for activities for persons with AD. Activities should be therapeutic, enhance quality of life, arrest mental decline, and generate and maintain self-esteem. Other purposes of activities for this population are to create immediate pleasure, re-establish dignity, provide meaningful tasks, restore roles, and enable friendships. Activities may be more important to the psychological state of well-being of persons with dementia than the general physical and social environments in which they live. SOURCES The literature reviewed was identified with the use of computer data bases (Medline - 1991-March 2001; Cumulative Index of Nursing and Allied Health Literature (CINAHL) - 1991-March 2001; and PsychLit - 1988-March 1999). In addition, data bases of Science Citation Index and Social Science Citation Indexes as they appear in the computer base, Web of Science, were searched for 1992-2001. The time period for each search was determined by the manner in which the literature was grouped for inclusion in the particular database. Hand searches of 11 selected journals included the years 1993-2001. The search dates were selected to reflect the time period when the largest number of studies on activities and AD have appeared in the professional literature. We critique a total of 33 studies. CONCLUSIONS While researchers have demonstrated interest in the use of activities with persons with AD, theoretical and methodological difficulties, unclear findings and gaps exist, including a lack of emphasis on gender, ethnic, racial or cultural differences. Sampling issues involving diagnosis and staging complicate the research on individuals with AD. Case studies, single subject experimental designs, and tightly controlled quasi-experimental and experimental designs are needed to advance knowledge in this important area.