Snoezelen for dementia.

Background Snoezelen, multi-sensory stimulation, provides sensory stimuli to stimulate the primary senses of sight, hearing, touch, taste and smell, through the use of lighting effects, tactile surfaces, meditative music and the odour of relaxing essential oils. The rationale for this lies in the proposition that the provision of a sensory environment for people with dementia places fewer demands on their intellectual abilities but capitalizes on their residual sensorimotor abilities. The clinical application of snoezelen often varies in form, nature, principles and procedures. Such variations not only make the examination of the therapeutic values of snoezelen difficult, but also impede the clinical development of snoezelen in dementia care. A systematic review of evidence for the efficacy of snoezelen in the care of people with dementia is therefore needed to inform future clinical applications and research directions. Objectives To examine the clinical efficacy of snoezelen (or multisensory stimulation) for older people with dementia and their caregivers. Search methods The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS were searched on 23 March 2008 using the terms: snoezelen OR "multi-sensory*". The CDCIG Specialized Register contains records from all major health care databases (The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS) as well as from many trials databases and grey literature sources. The reviewers hand-searched PubMed and the ISI Web of Science. Selection criteria Randomized controlled trials and quasi-randomized controlled trials in which snoezelen or multi-sensory programmes was used as an intervention for older people suffering from any forms of dementia. Data collection and analysis The two reviewers independently reviewed and assessed the quality of the trials. Main results Two new trials were included in this update. Baker 2003 was an expanded study of Baker 2001 reported in the previous version. Both Baker 2003 and van Weert 2005 examined the short-term and longer-term effects of snoezelen on behaviour, mood, and communication of people with moderate to severe dementia. The format of implementation was different in the two trials: one was session-based snoezelen programme (Baker 2003), whilst the other was a 24-hour integrated snoezelen care (van Weert 2005). Owing to the differences in study methodology, the results of the two trials were not pooled for analysis. The session-based snoezelen programme (Baker 2003) did not show any effects on behaviour, mood, cognition and communication / interaction in the short term (during or immediately after sessions) or longer term (at post-intervention or 1-month post-intervention follow-up). Likewise, the 24-hour integrated snoezelen care (van Weert 2005) failed to demonstrate any significant short-term and longer term effects on behaviour, mood and interaction. Authors' conclusions A more vigorous review methodology was adopted in this update. The study of Kragt 1997, reported in the previous version, was excluded because the snoezelen programme only consisted of three sessions, which was considered too brief for a therapeutic intervention. Two new trials were reviewed. Meta-analyses could not be performed because of the limited number of trials and different study methods of the available trials. Overall, there is no evidence showing the efficacy of snoezelen for dementia. There is a need for more reliable and sound research-based evidence to inform and justify the use of snoezelen in dementia care.