Dementia case management and risk of long‐term care placement: a systematic review and meta‐analysis

Tam-Tham, Helen; Cepoiu‐Martin, Monica; Ronksley, Paul E.; Maxwell, Colleen J.; Hemmelgarn, Brenda R.

doi:10.1002/gps.3906

Cited by 66 publications

(92 citation statements)

References 40 publications

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“…A number of systematic reviews have been reported of studies assessing the impact of case management on older people with dementia. [183][184][185][186][187][188][189] In general, studies have provided conflicting information about the potential benefits and duration of effect of case management for people with dementia. A recent Cochrane review of case management for PLWD found that the case management group was significantly less likely to be institutionalised at 6 and 12 months than those not receiving case management, although the longer-term effects were uncertain.…”

Section: Co-ordination and Navigationmentioning

confidence: 99%

“…Despite positive benefits for both PLWD and their carers in some individual trials, 230 recent systematic reviews have found little clinical effectiveness or cost-effectiveness evidence to support widespread case management implementation beyond some quality-of-life benefits. 186,188,189 A recent pilot trial to evaluate the feasibility of case management in the UK struggled to successfully implement a nurse/social worker case manager intervention despite considerable support for this care approach from both patients and primary care teams. 190 However, this was largely because of the study coinciding with considerable organisational change within primary care.…”

Section: Holistic Carementioning

confidence: 99%

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Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

116

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BackgroundAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population.ObjectivesTo explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population.DesignWe undertook a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). We focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.ParticipantsThe study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.ResultsThe scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. Our qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Although we found examples of good practice, these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.ConclusionsSignificant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Co-ordination and Navigationmentioning

confidence: 99%

Section: Holistic Carementioning

confidence: 99%

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

116

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Section: Vladimir Khanassov MD Msc Isabelle Vedel Md Phdmentioning

confidence: 99%

“…[14][15][16][17][18][19][20][21][22] Over the last few years, several systematic reviews have found that the evidence of CM's effects on service use and clinical outcomes is weak. [23][24][25][26][27][28] None of them specifically focused on the needs of patients and caregivers, however. [23][24][25][26][27][28] Patients with dementia and their caregivers who already receive professional care still report unmet needs.…”

mentioning

confidence: 99%

“…[23][24][25][26][27][28] None of them specifically focused on the needs of patients and caregivers, however. [23][24][25][26][27][28] Patients with dementia and their caregivers who already receive professional care still report unmet needs.29 Moreover, they feel that their own opinion is not taken into account. 30 In line with the patient-centered care paradigm, 31,32 it is important to identify the needs felt by the patient and the caregiver [33][34][35] and to determine the extent to which CM interventions respond to their needs.…”

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confidence: 99%

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Family Physician–Case Manager Collaboration and Needs of Patients With Dementia and Their Caregivers: A Systematic Mixed Studies Review

Khanassov

Vedel

2016

Ann Fam Med

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PURPOSE Dementia case management (CM) in primary care is a complex intervention aimed at identifying the various needs of patients with dementia and their caregivers, as well as the organization and coordination of care. A key element of CM is the collaboration of family physicians with case managers. We conducted a systematic mixed-studies review to identify the needs of the patientcaregiver dyad and the effects of CM. METHODSWe searched MEDLINE, PsycINFO, and EMBASE up to October 2014, regardless of the study design. Our main outcomes were needs of patients and their caregivers and the effects of CM on these needs. We used narrative syntheses to develop a taxonomy of needs and to describe the effects of CM on those needs. We used meta-analysis to calculate the prevalence of needs and the standardized mean differences to evaluate the effects of CM on the needs identified.RESULTS Fifty-four studies were included. We identified needs of the patientcaregiver dyad and needs of the patient and caregiver individually. CM addressed the majority of the identified needs. Still, some very common needs (eg, early diagnosis) are overlooked while other needs (eg, education on the disease) are well addressed. Fully establishing the value of CM is difficult given the small number of studies of CM in primary care.CONCLUSIONS There is good evidence that case managers, in collaboration with family physicians, have a pivotal role in addressing the needs of the patientcaregiver dyad. 2016;14:166-177. doi: 10.1370/afm.1898. Ann Fam Med INTRODUCTIONT he proportion of people with dementia is growing dramatically. According to the US Alzheimer's Association, by 2030, 50% of Americans aged 65 years and older will be diagnosed with dementia. 1 In Canada in 2011, 747,000 Canadians lived with cognitive impairment.2 Today, the combined costs are $33 billion per year, 1 and they are projected to increase to $872 billion by 2038. 3,4 Worldwide, dementia is the main contributor to disability-adjusted life years (11.2%), representing a greater burden than cerebral vascular accident (9.5%), heart disease (5.0%), or cancer (2.4%). 5People with dementia need help with challenging changes in behavior, memory, physical disability, and mood. 6 The main source of help is family caregivers, who often suffer from the burdens of caregiving and from depression and health problems. 7 It has been shown that early intervention makes the greatest difference in management of symptoms. 1 The World Health Organization states that it would be challenging to intervene without effective involvement of primary care. 8 Dementia case management (CM) interventions are becoming a central component of primary health care organizations in North America and Europe. [9][10][11][12] According to the 167Case Management Society of America, case management is "a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communi...

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A lzheimer's Disease and Families

Boylstein

2016

Encyclopedia of Family Studies

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Alzheimer's disease (AD) is becoming an increasing concern for older adults and their families. While there is evidence that a genetic cause exists for AD, the majority of AD diagnoses occur without a family history of the disease. Patients with AD must work with healthcare practitioners, family members, and other community resources (e.g., religious and home therapy agents) to develop a care plan that the patient feels is best for him/her. Reduced stigma and patient empowerment are major factors in long‐term outcomes for families dealing with AD, keeping the patient at home and in their his/her community for as long as possible. Limited government resources may be best served in strengthening relationships between patient, family, community, and multidisciplinary healthcare team, which is the best way of limiting hospital visits and thus reducing the overall healthcare costs associated with AD.

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Dementia case management and risk of long‐term care placement: a systematic review and meta‐analysis

Cited by 66 publications

References 40 publications

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Family Physician–Case Manager Collaboration and Needs of Patients With Dementia and Their Caregivers: A Systematic Mixed Studies Review

A lzheimer's Disease and Families

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