The purpose of this scoping review was to examine the science related to non-pharmacological interventions designed to slow decline for older adults with Mild Cognitive Impairment or early-stage dementia. We reviewed 32 unique randomized controlled trials that employed cognitive training (remediation or compensation approaches), physical exercise, or psychotherapeutic interventions that were published before November 2014. Evidence suggests that cognitive training focused on remediation and physical exercise interventions may promote small improvements in selected cognitive abilities. Cognitive training focused on compensation interventions and selected psychotherapeutic interventions may influence how cognitive changes impact daily living. However, confidence in these findings is limited due methodological limitations. To better assess the value of non-pharmacological interventions for this population, we recommend: 1) adoption of universal criteria for “early stage cognitive decline” among studies, 2) adherence to guidelines for the conceptualization, operationalization, and implementation of complex interventions, 3) consistent characterization of the impact of interventions on daily life, and 3) long-term follow-up of clinical outcomes to assess maintenance and meaningfulness of reported effects over time.

OBJECTIVES To determine the effect of integrating informal caregivers into discharge planning on post-discharge cost and resource utilization in the older adult population. DESIGN A systematic review and meta-analysis of randomized controlled trials that examine the effect of discharge planning with caregiver integration begun prior to patient discharge on healthcare cost and resource utilization outcomes. MEDLINE, EMBASE and the Cochrane Library databases were searched for all English language articles published between 1990 and April 2016. SETTING Hospital or skilled nursing facility. PARTICIPANTS Older adults with informal caregivers discharged to a community setting. MEASUREMENTS Readmission rates, length of and time to post-discharge rehospitalizations, costs of post-discharge care. RESULTS Of 10,715 abstracts identified, fifteen studies met the inclusion criteria. Eleven studies provided sufficient detail to calculate readmission rates for treatment and control. Compared to usual care, discharge planning interventions with caregiver integration were associated with a 25 percent reduction in readmissions at 90 days (Relative Risk [RR], .75 [95% CI, .62-.91]) and a 24 percent reduction in readmissions at 180 days (Relative Risk [RR], .76 [95% CI, .64–.90]). The majority of studies reported statistically significant reductions in time to readmission, length of rehospitalization, and costs of post-discharge care. CONCLUSION For older adult patients discharged to a community setting, the integration of caregivers into the discharge planning process, compared to non-systematic inclusion of caregivers, reduces the risk of hospital readmission.

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Fundamental changes are needed in the way we identify, assess, and support caregivers. Educational and workforce development reforms are needed to enhance the competencies of healthcare and long-term service providers to effectively engage caregivers.