Effectiveness of Telephone Interventions for the Management of Behavioral and Psychological Symptoms of Dementia in the Community: Systematic Review

Abstract

Background: Most people living with dementia experience behavioral and psychological symptoms of dementia (BPSD), leading to poor quality of life and hospitalizations and causing a significant burden for informal caregivers and health care systems, with a global lack of equitable support to manage these symptoms in the community. Telephone interventions can potentially improve the accessibility and flexibility of long-term dementia support. Objective: This systematic review evaluates the effectiveness of telephone interventions in managing BPSD for community-dwelling patients with dementia and their informal caregivers, and thereby reducing BPSD-related hospitalizations. Methods: A systematic search of 4 databases (MEDLINE, Embase, PsycInfo, and SCOPUS) was conducted. The authors included studies with telephone interventions with no blended component (ie, other technologies or in-person portion) and outcomes assessing the impact of these interventions on people with dementia, informal caregivers, and hospitalizations using quantitative measures. The risk of bias of the studies was measured using the National Heart, Lung, and Blood Institute assessment tools. Findings were analyzed applying a thematic synthesis approach. Results: Of 4355 studies screened in 2024, 12 met the inclusion criteria. Studies were conducted in 5 high-income countries, and the majority were randomized controlled trials, with 2 non-randomized controlled trials and 2 pre-post intervention studies. Interventions included telephone coaching calls, psychosocial and educational support calls, and online platforms. Most studies showed a reduction in BPSD and BPSD-related burden; however, the certainty of this evidence was rated as low according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) analysis. In total, 9 studies reported reduced BPSD, and 5 studies showed a statistically significant decrease, while 4 studies indicated significant improvements in BPSD-related caregiver burden. One study considered BPSD-related hospital admissions, reporting a statistically significant reduction in admission rates. Conclusions: Telephone interventions delivered through psychosocial and educational calls and online platforms are promising tools for reducing BPSD-related caregiver burden. Personalized telephone interventions, including patients and informal caregivers in the treatment plan, may improve behavioral and psychological symptoms in patients with dementia. However, the certainty of evidence for both outcomes was low; therefore, these findings should be interpreted with caution. To strengthen the evidence base and assess the global applicability of such interventions, high-quality studies—particularly in low- and middle-income countries—are needed. Future research should incorporate longer follow-up periods, cost-effectiveness analyses, and greater consistency in intervention design and outcome measurement to better inform clinical practice and policy.