A Systematic Review on Navigation Programs for Persons Living With Dementia and Their Caregivers

Abstract

Background and Objectives System navigation programs are becoming more available to meet the needs of patients with complex care needs. The aim of this review was to systematically assess the outcomes of navigation programs for persons with dementia and their family caregivers. Research Design and Methods A systematic review methodology was employed. Ten databases were searched for all relevant articles published until October 30, 2021. English-language full text articles were included if they focused on implemented navigation program(s) that primarily supported persons with dementia who were aged 50 or older. Methodological quality was assessed by at two independent raters using the Physiotherapy Evidence Database Scale, the STrengthening the Reporting of OBservational studies in Epidemiology checklist and The Mixed Methods Appraisal Tool. Results Fourteen articles were included in the review. There was Level 1 evidence for the benefits of system navigation programs on delaying institutionalization, wherein benefits appeared to be specific to interventions that had an in-person component. There was Level 1 (n=4) and Level 3 (n=1) evidence on service use from time of diagnosis to continued management of dementia. Finally, Level 1 to Level 5 evidence indicated a number of benefits on caregiver outcomes. Discussion and Implications There is strong evidence on the benefits of system navigation for people with dementia on delaying institutionalization and caregiver outcomes, but outcomes across other domains (i.e., functional independence) are less clear, which may be due to the varied approaches within system navigation models of care.

Dementia care navigation: A systematic review on different service types and their prevalence

“…Findings therefore advance a recent review 19 Clinical Commissioning Group survey in England about care navigation 37 Whilst different DCN services were reported on from various angles, overall, there was limited evidence on the impact on service access. Specifically, evidence only showed some reductions in health care utilisation, including reduced hospital admissions and reduced healthcare costs, and some spending redistributions to in-home services compared to institutional long-term care and nonsignificant reductions in caregiving services.…”

“…This systematic review is the first to compare existing published DCN services of non‐clinically qualified professionals providing care navigation to people with dementia and their carers, and synthesises the evidence on different outcomes of dementia and service utilisation. Findings therefore advance a recent review 19 which focused solely on different outcomes and did not provide a framework for how effective DCN services are structured and run. This review provides novel insights into the different formats of DCN services, training requirements, engagement levels and formats that are currently reported on, and the fact that only DCN services in the US are published.…”

“…18 The report highlighted patient and staff satisfaction and increased signposting and access to care of the DCN service piloted in primary care settings in Gateshead and Halton. To date, one systematic review 19 has explored different system navigation programmes for dementia, albeit focusing solely on outcomes, specifically admissions to long-term care, and has not provided a comparison of different service formats and how these may influence different community-based outcomes (such as everyday functioning, well-being, and health and social care service utilisation).…”

Perceptions and outcomes of an embedded Alzheimer Society First Link Coordinator in rural primary health care memory clinics

“…Recent reviews of dementia navigation [ 28 , 29 ] have identified some positive outcomes related to service use but agree that there is not enough evidence to make substantial conclusions. Giebel et al [ 28 ] conclude that there is mixed evidence on effectiveness of care navigation, despite studies showing sizable benefits for some outcomes, and stress the need for more evaluation of impact on care utilization and in countries outside the USA which does not have universal health coverage.…”

Competency development for a volunteer navigation program to support caregivers of people living with dementia: A modified e-Delphi method

“…The use of navigation interventions in dementia care has been emerging over recent years (Amjad et al, 2017; Backhouse et al, 2017; Bernstein et al, 2020; Black et al, 2019; Zwingmann et al, 2019). Dementia navigation programs vary but generally utilize a non-clinical staff member to provide person-centered care and assist care-partners and people living with dementia to access existing services and supports within their communities, ultimately improving care integration (Giebel et al, 2023; Kokorelias et al, 2023). These programs have contributed to improvements in the behaviours of people living with dementia, decreased their healthcare utilization, and improved care-partner burden (Amjad et al, 2017; Backhouse et al, 2017; Bernstein et al, 2019; Bernstein et al, 2020; Black et al, 2019; Zwingmann et al, 2019).…”