Effectiveness of case management among older adults with early symptoms of dementia and their primary informal caregivers: A randomized clinical trial

Abstract

This study shows no benefits of case management for older adults with dementia symptoms and their primary informal caregivers. One possible explanation is that case management, which has been recommended among diagnosed dementia patients, may not be beneficial if offered too early. However, on the other hand, it is possible that: (1) case management will be effective in this group if more fully implemented and adapted or aimed at informal caregivers who experience more severe distress and problems; (2) case management is beneficial but that it is not seen in the timeframe studied; (3) case management might have undetected small benefits. This has to be established. Trial registration ISCRTN83135728.

Support at Home: Interventions to Enhance Life in Dementia (SHIELD) – evidence, development and evaluation of complex interventions

“…Trials that do not produce positive findings appear less likely to be published and this can lead to a risk of a biased set of studies included in systematic reviews. However, there is likely to be very low risk of publication bias for this review, as our comprehensive search strategy did not restrict searches to peer-reviewed journals only; HOME TREATMENT PROGRAMME: DEVELOPMENT OF A HOME TREATMENT PACKAGE NIHR Journals Library www.journalslibrary.nihr.ac.uk for example, the Jansen et al 176 study was a PhD (Doctor of Philosophy) conducted in the Netherlands and was included as a trial in this review. We cannot rule out the possibility that we have missed unpublished trials with negative results but, overall, the risk of publication bias in this review was low.…”

Family Physician–Case Manager Collaboration and Needs of Patients With Dementia and Their Caregivers: A Systematic Mixed Studies Review

“…Fixed-effects models were used because of the small sample size (2 in each outcome evaluation). 16,17,19,21,22 and problematic home situations.…”

“…Fixed-effects models were used because of the small sample size (2 in each outcome evaluation). 16,17,19,21,22 and problematic home situations.18 They counseled on available resources/ services, 16,20 legal and financial issues, and advance directives.14-16 Finally, case managers coordinated medical and community services via electronic, written, and case conference discussion. [14][15][16][17]19,20 To meet the needs of patients, case managers applied, in collaboration with family physicians, nonpharmacologic and pharmacologic protocols for management of daily activities, [14][15][16] behavior distress, [14][15][16]21,22 cognition, 14-16 mood, [14][15][16] and home safety.…”

“…16,17 The effects on the needs for early diagnosis, financial and legal aspects of the disease, and meaningful activities were not studied. CM was not found to have any effect on patients' daily activities, cognition and depression.A meta-analysis of the effects of CM (Figure 1 and Supplemental Appendix 4, available at http:// 61,62,66,73,74,76,81,85,91,93,95,97 Canada 84 USA [14][15][16] Europe (21 studies) UK 20,52,53,64,69,72,77,78,83,84,99 The Netherlands The effect on depression of caregivers was uncertain (SMD -0.23, 95% CI, -0.46 to 0.01, P = .06), 14,17,18 and there was no effect on caregivers' burden (SMD 0.17, 95% CI, -0.18 to 0.52, P = .34). …”

“…They work in collaboration with family physicians, specialists, or both. [14][15][16][17][18][19][20][21][22] Over the last few years, several systematic reviews have found that the evidence of CM's effects on service use and clinical outcomes is weak. [23][24][25][26][27][28] None of them specifically focused on the needs of patients and caregivers, however.…”