aggression, stress, and anxiety in patients with dementia. Moreover, massage therapy can be beneficial for nursing personnel involved in taking care of patients with dementia. The combination of massage with aromatherapy seems to impart the most significant results in patients with dementia. AUTHOR DISCLOSURE STATEMENT The authors declare that they do not have any conflicts of interest related to the study. 4. Brooker DJ, Snape M, Johnson E, Ward D, Payne M. Single case evaluation of the Evidence Update 2018 Managing Agitation and Aggression in Long-Term Care Residents with Dementia Background In 2014, the Contextualized Health Research Synthesis Program (CHRSP) published a contextualized health evidence synthesis report on interventions, strategies, and/or practices that have proven effective in preventing and managing agitation and aggression among LTC residents with dementia and that did not involve the use of physical restraints or psychotropic drugs. The Project Team was led by Dr. Neena Chappell, Canada Research Chair in Social Gerontology and Professor of Sociology at the University of Victoria. The original study is available on the CHRSP website.1 This synthesis update adds the findings of systematic reviews published since 2014. The CHRSP team did not have the resources to fully assess the original and updated evidence with our new evidence rating system. Instead, we attempted to align the more lenient evidence rating system that had been used for the original report with our current more comprehensive and conservative methodology. The evidence synthesis in this update is more conservative and rigorous than in the original, but not as conservative or rigorous as our more recent and ongoing CHRSP projects. A comparison between the evidence rating systems of the original report and of this update is available in the Appendix, which starts on Page 19. The evidence rating system for this update assesses the strength of the combined body of evidence for a particular intervention to achieve a given outcome for a defined population. The strength of the body of evidence increases with the quality of the systematic review, the number of unique primary research studies included in the evidence synthesis, and the consistency of the findings. We use the AMSTAR instrument to appraise the quality of systematic reviews (range: 0, low—11, high)(1) and categories of methodological quality based on the original report: 0-3 = Low, 4-7 moderate, 8-11 high. Inconsistent findings are interpreted as a “Very Weak” body of evidence by default (see Table 1). Body of Evidence # of Systematic Reviews # of Primary Studies Strong 2+ High Quality 10+ Moderate 1+ High Quality 10+ Weak 1+ High Quality 5+ Very Weak 1 Moderate Inconsistent Findings 1-4 Table 1: Evidence thresholds for Strength of Body of Evidence categories if findings are consistent. The evidence rating system also considers whether or not the evidence favours the intervention group (i.e., the intervention is works), or indicates no benefit compared to the control group (i.e., the 1 Managing Agitation and Aggression in Long-Term Care Residents with Dementia 4 intervention is not effective), or is unable to indicate if the intervention group achieved better outcomes than the control group (i.e., unable to draw a conclusion). Research Question for this Synthesis “Other than use of physical restraints or prescription of psychotropic medications, what interventions, strategies, and/or practices have proven effective in preventing and managing agitation and aggression in long term care residents with dementia?” Results We included 25 systematic reviews in this update. Eleven were high quality and 14 were of moderate quality. Nine reviews were appraised as low quality and excluded from the synthesis. The inter-rater reliability for appraising methodological quality was 0.81, which is considered high (2Eligible systematic review critical appraisal results. Overview A surprisingly large number of systematic reviews have been published between 2014 and 2018 that address non-pharmacological interventions to reduce aggression/agitation among LTC residents with dementia. This increase in the number of systematic reviews is indicative of the increased interest in the topic, as well as a diversification in the study of potential interventions. However, this increase in research product since the original report was not matched by an increase in clarity. Systematic reviews frequently cited an insufficient quantity or quality of evidence from which to draw conclusions. Interventions with more than one systematic review often had findings that were not consistent or were contradictory. We observed that systematic reviews with better methodological quality and more rigorous standards tended to find smaller or no effect sizes compared to reviews with lower quality or less rigorous standards. The limitations of systematic reviews to indicate effective and not effective interventions are directly related to the quality of the underlying primary research evidence. Systematic reviews in this update routinely cautioned that the included studies had significant limitations. These included: imprecision in measurement, using different measures across studies, issues in terminology describing interventions, a critical lack of detail in describing