A randomized controlled trial to examine the effectiveness of case management model for community dwelling older persons with mild dementia in Hong Kong

Lam, Linda Chiu Wa; Lee, Jenny S.W.; Chung, Jenny C. C.; Lau, Andy T. Y.; Woo, Jean; Kwok, Timothy

doi:10.1002/gps.2352

Cited by 63 publications

(81 citation statements)

References 19 publications

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“…The characteristics of participants in our study were similar to those of the previous studies, i.e. mainly females with a secondary or lower education level and a low income [45,46,47]. …”

Section: Discussionsupporting

confidence: 68%

The Effects of Mindfulness-Based Stress Reduction Program on the Mental Health of Family Caregivers: A Randomized Controlled Trial

Hou

Wong

Yip

et al. 2013

Psychother Psychosom

116

103

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Background: Caregivers of people with chronic conditions are more likely than non-caregivers to have depression and emotional problems. Few studies have examined the effectiveness of mindfulness-based stress reduction (MBSR) in improving their mental well-being. Methods: Caregivers of persons with chronic conditions who scored 7 or above in the Caregiver Strain Index were randomly assigned to the 8-week MBSR group (n = 70) or the self-help control group (n = 71). Validated instruments were used to assess the changes in depressive and anxiety symptoms, quality of life, self-efficacy, self-compassion and mindfulness. Assessments were conducted at baseline, post-intervention and at the 3-month follow-up. Results: Compared to the participants in the control group, participants in the MBSR group had a significantly greater decrease in depressive symptoms at post-intervention and at 3 months post-intervention (p < 0.01). The improvement in state anxiety symptoms was significantly greater among participants in the MBSR group than those of the control group at post-intervention (p = 0.007), although this difference was not statistically significant at 3 months post-intervention (p = 0.084). There was also a statistically significant larger increase in self-efficacy (controlling negative thoughts; p = 0.041) and mindfulness (p = 0.001) among participants in the MBSR group at the 3-month follow-up compared to the participants in the control group. No statistically significant group effects (MBSR vs. control) were found in perceived stress, quality of life or self-compassion. Conclusions: MBSR appears to be a feasible and acceptable intervention to improve mental health among family caregivers with significant care burden, although further studies that include an active control group are needed to make the findings more conclusive.

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“…The characteristics of participants in our study were similar to those of the previous studies, i.e. mainly females with a secondary or lower education level and a low income [45,46,47]. …”

Section: Discussionsupporting

confidence: 68%

The Effects of Mindfulness-Based Stress Reduction Program on the Mental Health of Family Caregivers: A Randomized Controlled Trial

Hou

Wong

Yip

et al. 2013

Psychother Psychosom

116

103

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“…Ten studies were conducted in the USA,10,12,27,36,39,40,43,45,48,50 five in the UK,42,46,47,49,51 and four in the Netherlands 32,41,52,54. The remaining four studies were from Belgium,31 Australia,53 India,34 and People’s Republic of China 35,55. All articles were published in English.…”

Section: Resultsmentioning

confidence: 99%

“…Low intensity (eg, large caseload, infrequent follow-up, low fidelity, partial completion of the designed intervention) was associated with an absence of outcomes for the patient-caregiver dyad 31,35,36,41. A large caseload was considered the factor that changed the proactive nature of dementia care (aimed at preventing a crisis) toward a more reactive approach (dealing with crises) 43,44,54.…”

Section: Resultsmentioning

confidence: 99%

Case management for dementia in primary health care: a systematic mixed studies review based on the diffusion of innovation model

Khanassov¹,

Vedel²,

Pluye³

2014

CIA

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BackgroundThe purpose of this study was to examine factors associated with the implementation of case management (CM) interventions in primary health care (PHC) and to develop strategies to enhance its adoption by PHC practices.MethodsThis study was designed as a systematic mixed studies review (including quantitative and qualitative studies) with synthesis based on the diffusion of innovation model. A literature search was performed using MEDLINE, PsycInfo, EMBASE, and the Cochrane Database (1995 to August 2012) to identify quantitative (randomized controlled and nonrandomized) and qualitative studies describing the conditions limiting and facilitating successful CM implementation in PHC. The methodological quality of each included study was assessed using the validated Mixed Methods Appraisal Tool.ResultsTwenty-three studies (eleven quantitative and 12 qualitative) were included. The characteristics of CM that negatively influence implementation are low CM intensity (eg, infrequent follow-up), large caseload (more than 60 patients per full-time case manager), and approach, ie, reactive rather than proactive. Case managers need specific skills to perform their role (eg, good communication skills) and their responsibilities in PHC need to be clearly delineated.ConclusionOur systematic review supports a better understanding of factors that can explain inconsistent evidence with regard to the outcomes of dementia CM in PHC. Lastly, strategies are proposed to enhance implementation of dementia CM in PHC.

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“…Most of the studies with positive findings report improvements in measures such as caregiver burden or stress, 30,35,41 caregiver confidence, 29 negative feelings about the patient, 31 function 35 and uptake of community services. 37,42 Moreover, in Mittelman's study, 40 spouse caregivers' reactions to memory loss and challenging behaviour (BPSD), and satisfaction with social support, accounted for at least 30% of the effect of the intervention on nursing home admission. Reducing caregivers' negative reactions to memory loss and BPSD accounted for 48.7% of the intervention's impact, whereas depressive symptoms and frequency of BPSD were weaker (but still significant) mediators of the intervention effects.…”

Section: Clinical and Economic Effectivenessmentioning

confidence: 99%

The effectiveness of collaborative care for people with memory problems in primary care: results of the CAREDEM case management modelling and feasibility study

Iliffe

Waugh

Poole

et al. 2014

Health Technology Assessment

227

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BackgroundPeople with dementia and their families need support in different forms, but currently services are often fragmented with variable quality of care. Case management offers a way of co-ordinating services along the care pathway and therefore could provide individualised support; however, evidence of the effectiveness of case management for dementia is inconclusive.ObjectiveTo adapt the intervention used in a promising case management project in the USA and test its feasibility and acceptability in English general practice.DesignIn work package 1, a design group of varied professionals, with a carer and staff from the voluntary sector, met six times over a year to identify the skills and personal characteristics required for case management; protocols from the US study were adapted for use in the UK. The feasibility of recruiting general practices and patient–carer dyads and of delivering case management were tested in a pilot study (work package 2). An embedded qualitative study explored stakeholder views on study procedures and case management.SettingFour general practices, two in the north-east of England (Newcastle) one in London and one in Norfolk, took part in a feasibility pilot study of case management.ParticipantsCommunity-dwelling people with dementia and their carers who were not already being case managed by other services.InterventionA social worker shared by the two practices in the north-east and practice nurses in the other two practices were trained to deliver case management. We aimed to recruit 11 people with dementia from each practice who were not already being case managed.Main outcome measuresNumbers of people with dementia and their carers recruited, numbers and content of contacts, needs identified and perceptions of case management among stakeholders.ResultsRecruitment of practices and patients was slow and none of the practices achieved its recruitment target. It took more than 6 months to recruit a total of 28 people with dementia. Practice Quality and Outcome Framework registers for dementia contained only 60% of the expected number of people, most living in care homes. All stakeholders were positive about the potential of case management; however, only one of the four practices achieved a level of case management activity that might have influenced patient and carer outcomes. Case managers’ activity levels were not related solely to time available for case management. Delivery of case management was hindered by limited clarity about the role, poor integration with existing services and a lack of embeddedness within primary care. There were discrepancies between case manager and researcher judgements about need, and evidence of a high threshold for acting on unmet need. The practice nurses experienced difficulties in ring-fencing case management time.ConclusionsThe model of case management developed and evaluated in this feasibility study is unlikely to be sustainable in general practice under current conditions and in our view it would not be appropriate to attempt a definitive trial of this model. This study could inform the development of a case management role with a greater likelihood of impact. Different approaches to recruiting and training case managers, and identifying people with dementia who might benefit from case management, are needed, as is exploration of the scale of need for this type of working.Trial registrationCurrent Controlled Trials ISRCTN74015152.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 18, No. 52. See the NIHR Journals Library website for further project information.

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A randomized controlled trial to examine the effectiveness of case management model for community dwelling older persons with mild dementia in Hong Kong

Abstract: Case management for Chinese persons with mild dementia outpatients did not show significant effects in reducing caregiver burden, but encouraged family caregivers to seek external support.

Cited by 63 publications

References 19 publications

The Effects of Mindfulness-Based Stress Reduction Program on the Mental Health of Family Caregivers: A Randomized Controlled Trial

The Effects of Mindfulness-Based Stress Reduction Program on the Mental Health of Family Caregivers: A Randomized Controlled Trial

Case management for dementia in primary health care: a systematic mixed studies review based on the diffusion of innovation model

The effectiveness of collaborative care for people with memory problems in primary care: results of the CAREDEM case management modelling and feasibility study

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