476 Case management beneficial for people with dementia

February 01, 2016

written by Brian R McAvoy

Clinical question
How effective are case management approaches to home support for people with dementia?

Bottom line
There was some evidence to suggest admissions to care homes and overall healthcare costs were reduced in the medium term (12 months); however, the results at longer points of follow-up were uncertain. There was not enough evidence to clearly assess whether case management could delay institutionalisation in care homes. There were uncertain results for patient depression, functional abilities and cognition. All but 3 of the RCTs had a duration of 12 months or more, but only 6 trials lasted 18 months or more. The studies included in this review came from a variety of countries and contexts: the US, Canada, Finland, Netherlands, Hong Kong, India and the UK; and from primary care practices, dementia resource centres, memory clinics, outpatient clinics and day centres.

Caveat
There was heterogeneity between the participants' demographic characteristics, types of dementia, intervention components, delivery methods, outcome measures and follow-up periods. There were also large variations in the sample sizes within studies.

Context
Over 35 million people are estimated to be living with dementia worldwide, and the societal costs are very high. Case management is a widely used and strongly promoted complex intervention for organising and coordinating care at the level of the individual. The aim of its use for people with dementia is to provide long-term care in the community, as an alternative to early admission to a care home or hospital.

Cochrane Systematic Review
Reilly S et al. Case management approaches to home support for people with dementia. Cochrane Reviews, 2015, Issue 1. Art. No.: CD008345.DOI: 10.1002/14651858. CD008345.pub2. This review contains 13 studies involving 9615 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.