No abstract

The growing number of dementia patients leads to both policy, economic and health organization constraints. Many healthcare systems have developed case management programs in order to optimize dementia patients and caregivers care and services delivery. Nevertheless, to what extend case management programs can lead to an improvement of care and expenditures savings is not known. Thus, the objective of this paper was to analyse the efficacy of case management programs on health care cost, institutionalization and hospitalization. A systematic review of randomized controlled trials was therefore conducted of the databases MEDLINE and SCOPUS up to September 2009. Included were English language randomized controlled trials of case management for community dwelling dementia patients and their caregivers evaluating costs, institutionalization and hospitalization. An evaluation of the methodological quality was performed. Thirteen relevant studies concerning 12 trials were identified and included. None of the 7 low quality studies reported positive impact of case management on the outcomes of interest. Among the 6 good quality studies, 4 reported positive impact on institutionalization delay, institutionalization length or nursing home admission rate. In none of the good quality studies was evidence found for savings in health care expenditures or reduction in hospitalization recourse. The weak convincing evidences from randomized trials do not allow any conclusion about the efficacy of case management for dementia patient and caregivers on costs and resource utilization. Further research should focus on determining subgroups of caregivers who could benefit the most from case management.

Living alone is associated with elevated mortality, especially among men and an increased risk of institutionalization. Over a 6-year period, living alone was related to a half year reduction in survival among elderly people in Sweden.

Living alone is associated with higher risks of unplanned hospitalization in elderly, especially for men.

People with incipient dementia are more prone to hospitalization for PCSCs but not to all-cause hospitalization.

OT may be an effective intervention to maintain cognition and functionality and to reduce psychiatric symptoms in dementia patients. Mild stages of dementia could gain more benefits from OT with regard to functional decline.

Neither recourse to a specialist nor recourse to GP improve survival of new dementia cases. Those who had consulted a specialist early in the disease course even reported a worse life expectancy than those who did not.

The 2008-2012 French Alzheimer plan has proposed measures to improve care for dementia patients in a more personalized and graduate approach owing to patients and caregivers needs. A key measure of the plan is the nationwide implementation of the MAIA (French acronym for Maison pour l'Autonomie et l'Intégration des malades d'Alzheimer). The main goal is to implement a process of integration through a network of partners involved in elderly care, assistance, or support. The MAIA model comprises tools and mechanisms necessary to improve the integrated care process; in particular, case management for elderly in complex situations. The purpose of this paper is to describe the main measures from the national plan that aim to improve care for dementia patients with an emphasis on the MAIA measure. We summarize initial results of case management activity in one MAIA in the South West of France and we present two vignettes of cases benefiting from case management in order to demonstrate the nature of intervention. The French Alzheimer plan has promoted several non-pharmacological strategies for dementia patients. Implementation of both integrated care and case management represent a challenging perspective for the elderly and health professionals.