Case management for integrated care of older people with frailty in community settings

Abstract

Background Ageing populations globally have contributed to increasing numbers of people living with frailty, which has significant implications for use of health and care services and costs. The British Geriatrics Society defines frailty as "a distinctive health state related to the ageing process in which multiple body systems gradually lose their inbuilt reserves". This leads to an increased susceptibility to adverse outcomes, such as reduced physical function, poorer quality of life, hospital admissions, and mortality. Case management interventions delivered in community settings are led by a health or social care professional, supported by a multidisciplinary team, and focus on the planning, provision, and co‐ordination of care to meet the needs of the individual. Case management is one model of integrated care that has gained traction with policymakers to improve outcomes for populations at high risk of decline in health and well‐being. These populations include older people living with frailty, who commonly have complex healthcare and social care needs but can experience poorly co‐ordinated care due to fragmented care systems. Objectives To assess the effects of case management for integrated care of older people living with frailty compared with usual care. Search methods We searched CENTRAL, MEDLINE, Embase, CINAHL, Health Systems Evidence, and PDQ Evidence and databases from inception to 23 September 2022. We also searched clinical registries and relevant grey literature databases, checked references of included trials and relevant systematic reviews, conducted citation searching of included trials, and contacted topic experts. Selection criteria We included randomised controlled trials (RCTs) that compared case management with standard care in community‐dwelling people aged 65 years and older living with frailty. Data collection and analysis We followed standard methodological procedures recommended by Cochrane and the Effective Practice and Organisation of Care Group. We used the GRADE approach to assess the certainty of the evidence. Main results We included 20 trials (11,860 participants), all of which took place in high‐income countries. Case management interventions in the included trials varied in terms of organisation, delivery, setting, and care providers involved. Most trials included a variety of healthcare and social care professionals, including nurse practitioners, allied healthcare professionals, social workers, geriatricians, physicians, psychologists, and clinical pharmacists. In nine trials, the case management intervention was delivered by nurses only. Follow‐up ranged from three to 36 months. We judged most trials at unclear risk of selection and performance bias; this consideration, together with indirectness, justified downgrading the certainty of the evidence to low or moderate. Case managem...

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Exploring stakeholders’ experiences of comprehensive geriatric assessment in the community and out-patient settings: a qualitative evidence synthesis

“…We found that across stakeholder groups there was consensus that CGA enabled a holistic assessment of older adults needs in community and OPD settings. This is an important finding as many older adults have complex and heterogeneous needs [ 44 ], with 17.4% of the community-dwelling population older adult population living with frailty [ 45 ]. Furthermore, the WHO promote a comprehensive assessment alongside care co-ordination as integral to the successful delivery of integrated clinical care to older adults, particularly within the community setting [ 7 ].…”

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“…The integrated care model, which is the one that was in operation in 2022 (with data collection in the period 2020–2021 are not assessable due to the COVID-19 pandemic), consists of a multidisciplinary assessment coordinated through a nurse case manager and a nursing home nurse (Sadler et al. , 2023).…”

“…However, this model faced significant difficulties due to the pressure of care, insufficient time and coordination between several care levels (Burgos-D ıez et al, 2020). The integrated care model The integrated care model, which is the one that was in operation in 2022 (with data collection in the period 2020-2021 are not assessable due to the COVID-19 pandemic), consists of a multidisciplinary assessment coordinated through a nurse case manager and a nursing home nurse (Sadler et al, 2023).…”