We recommend focusing on cognitive enhancement strategies, assessment and management of BPSD, and carer education and support to delay nursing home placement.

Analysis 1.3. Comparison 1 Case management versus usual care (primary outcomes), Outcome 3 Time to institutionalisation..... Analysis 1.4. Comparison 1 Case management versus usual care (primary outcomes), Outcome 4 Hospital admission

Mental health services and residential home staff need to be aware that many needs remain unmet and much can be done to improve the quality of life of the residents with dementia.

Quality of Life (QoL) is now an established outcome measure for people with dementia. There is a need to understand if measures are sensitive to change and what factors are associated with change in QoL in dementia to develop interventions to improve QoL and identify who may be most likely to benefit. This study aimed to assess change in QoL in people living in 24-hour care homes using the Quality of Life-Alzheimer's Disease (QOL-AD) scale and investigated which clinical factors predicted changes in QoL in dementia. We used the QOL-AD scale to rate individual and staff perceptions of residents' QoL, for 238 people with dementia, recruited from 24 care homes in the United Kingdom. A follow-up interview was undertaken at 20 weeks. One hundred ninety-two (80.7%) of the 238 residents interviewed at baseline were followed up. A reduction in residents' QoL was predicted by lower baseline depression and anxiety symptoms, higher baseline QoL ratings, and an increase in depressive symptoms and cognitive deterioration at follow-up. Although QoL does not necessarily diminish as dementia progresses, it is strongly influenced by the person with dementia's mood. Improvement in cognition and mood may lead to increased QoL.

Transition into ILTC seems to increase total costs of dementia care from a societal perspective. The prevention of long-term care placement might be cost reducing for European health systems. However, this conclusion depends on the country, on the valuation method for informal caregiving and on the degree of impairment.