Family Care as Collaboration: Effectiveness of a Multicomponent Support Program for Elderly Couples with Dementia. Randomized Controlled Intervention Study

Eloniemi‐Sulkava, Ulla; Saarenheimo, Marja; Laakkonen, Marja‐Liisa; Pietilä, Minna; Savikko, Niina; Kautiainen, Hannu; Tilvis, Reijo S.; Pitkälä, Kaisu H.

doi:10.1111/j.1532-5415.2009.02564.x

Cited by 84 publications

(121 citation statements)

References 47 publications

(101 reference statements)

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“…63 All 5 trials found no evidence of cost savings (Table 2). 15,55,57,58,63 Evidence From Nonrandomized Studies The results from nonrandomized studies showed findings similar to those of randomized controlled trials except for 2 outcomes: 2 studies showed cost-effectiveness of case management, 69,71 and 1 study achieved improvement in cognition.…”

Section: Description Of the Case Management Interventionsmentioning

confidence: 57%

“…A long duration of case management may produce positive outcomes for caregivers (2 studies). A small number of studies 12,13,56,57,60 (called outliers), however, did not follow the same pattern of configurations that can be explained by other factors (Supplemental Table 4). …”

Section: Barrier-outcome Configurationsmentioning

confidence: 99%

“…12,17,22,51,53,56,57,91 In the studies that showed a decrease in institutionalization, 48,64,67 the mean effect size was small (0.21). 48,67 In 2 of 5 studies, hospital admission decreased (mean effect size = 0.66).…”

Section: Description Of the Case Management Interventionsmentioning

confidence: 99%

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Barriers to Implementation of Case Management for Patients With Dementia: A Systematic Mixed Studies Review

Khanassov

Vedel

Pluye

2014

The Annals of Family Medicine

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PURPOSE Results of case management designed for patients with dementia and their caregivers in community-based primary health care (CBPHC) were inconsistent. Our objective was to identify the relationships between key outcomes of case management and barriers to implementation. METHODSWe conducted a systematic mixed studies review (including quantitative and qualitative studies). Literature search was performed in MEDLINE, PsycINFO, Embase, and Cochrane Library (1995 up to August 2012). Case management intervention studies were used to assess clinical outcomes for patients, service use, caregiver outcomes, satisfaction, and cost-effectiveness. Qualitative studies were used to examine barriers to case management implementation. Patterns in the relationships between barriers to implementation and outcomes were identified using the configurational comparative method. The quality of studies was assessed using the Mixed Methods Appraisal Tool.RESULTS Forty-three studies were selected (31 quantitative and 12 qualitative). Case management had a limited positive effect on behavioral symptoms of dementia and length of hospital stay for patients and on burden and depression for informal caregivers. Interventions that addressed a greater number of barriers to implementation resulted in increased number of positive outcomes. Results suggested that highintensity case management was necessary and sufficient to produce positive clinical outcomes for patients and to optimize service use. Effective communication within the CBPHC team was necessary and sufficient for positive outcomes for caregivers.CONCLUSIONS Clinicians and managers who implement case management in CBPHC should take into account high-intensity case management (small caseload, regular proactive patient follow-up, regular contact between case managers and family physicians) and effective communication between case managers and other CBPHC professionals and services.

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Section: Description Of the Case Management Interventionsmentioning

confidence: 57%

Section: Barrier-outcome Configurationsmentioning

confidence: 99%

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Barriers to Implementation of Case Management for Patients With Dementia: A Systematic Mixed Studies Review

Khanassov

Vedel

Pluye

2014

The Annals of Family Medicine

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“…PDC was created to address major issues reported by older adults with chronic illnesses and their caregivers, including fragmentation and lack of coordination between medical care and community services as well as difficulties among families in accessing and monitoring the quality of medical and non-medical services. 6,15 PDC assisted families by 1) providing disease-related education and information, 2) offering emotional support and coaching, 3) linking families to medical and non-medical services and resources, and 4) mobilizing and organizing the informal care network. The intervention was implemented by a half-time VHA dementia care coordinator (DCC) and a half-time AA care consultant (CC).…”

Section: Methodsmentioning

confidence: 99%

A Break-Even Analysis for Dementia Care Collaboration: Partners in Dementia Care

Morgan¹,

Bass

Judge

et al. 2015

J GEN INTERN MED

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BACKGROUND: Dementia is a costly disease. People with dementia, their families, and their friends are affected on personal, emotional, and financial levels. Prior work has shown that the BPartners in Dementia Care^(PDC) intervention addresses unmet needs and improves psychosocial outcomes and satisfaction with care. OBJECTIVE: We examined whether PDC reduced direct Veterans Health Administration (VHA) health care costs compared with usual care. DESIGN: This study was a cost analysis of the PDC intervention in a 30-month trial involving five VHA medical centers. PARTICIPANTS: Study subjects were veterans (N=434) 50 years of age and older with dementia and their caregivers at two intervention (N=269) and three comparison sites (N=165). INTERVENTIONS: PDC is a telephone-based care coordination and support service for veterans with dementia and their caregivers, delivered through partnerships between VHA medical centers and local Alzheimer's Association chapters. MAIN MEASURES: We tested for differences in total VHA health care costs, including hospital, emergency department, nursing home, outpatient, and pharmacy costs, as well as program costs for intervention participants. Covariates included caregiver reports of veterans' cognitive impairment, behavior problems, and personal care dependencies. We used linear mixed model regression to model change in log total cost post-baseline over a 1-year follow-up period. KEY RESULTS: Intervention participants showed higher VHA costs than usual-care participants both before and after the intervention but did not differ significantly regarding change in log costs from pre-to post-baseline periods. Pre-baseline log cost (p≤0.001), baseline cognitive impairment (p≤0.05), number of personal care dependencies (p≤0.01), and VA service priority (p≤0.01) all predicted change in log total cost. CONCLUSIONS: These analyses show that PDC meets veterans' needs without significantly increasing VHA health care costs. PDC addresses the priority area of care coordination in the National Plan to Address Alzheimer's Disease, offering a low-cost, structured, protocol-driven, evidence-based method for effectively delivering care coordination.KEY WORDS: costs and cost analysis; dementia; veterans.

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“…[164][165][265][266][267][268][269] Grade B, Level 2 + B End-of-life care for patients with dementia has been found to be extremely demanding of family caregivers. The burden experienced can be personal, emotional and economic and can result in significant levels of depression in the caregivers.…”

Section: Needs Of Caregiversmentioning

confidence: 99%

Systematic review of recent dementia practice guidelines

2014

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Level Type of Evidence + +High quality meta-analyses, systematic reviews of randomised controlled trials (RCTs), or RCTs with a very low risk of bias. +Well conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias. -Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias + +High quality systematic reviews of case control or cohort studies. High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal 2 + Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal -Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal 3Non-analytic studies, e.g. case reports, case series 4 Expert opinion Levels of evidence and grades of recommendation Statement of IntentThese guidelines are not intended to serve as a standard of medical care. Standards of medical care are determined on the basis of all clinical data available for an individual case and are subject to change as scientific knowledge advances and patterns of care evolve.The contents of this publication are guidelines to clinical practice, based on the best available evidence at the time of development. Adherence to these guidelines may not ensure a successful outcome in every case. These guidelines should neither be construed as including all proper methods of care, nor exclude other acceptable methods of care. Each physician is ultimately responsible for the management of his/her unique patient, in the light of the clinical data presented by the patient and the diagnostic and treatment options available. ForewordDementia represents a major public health concern in Singapore and worldwide. Being the most prevalent neurodegenerative disease, dementia is expected to affect 55,000 patients in Singapore by the year 2020. The commonest cause of dementia is Alzheimer's disease with vascular dementia being the next most important cause. Right from the stage of mild dementia up to the stages of severe dementia, this condition poses a significant health and socio-economic burden to patients, caregivers and the nation as a whole. Early diagnosis will allow appropriate use of pharmacological and non-pharmacological management. Along with disease stabilization, efforts to address caregiver burden, patient safety and medico legal concerns should form the principles of management. Clear practise guidelines will allow holistic and optimal care in dementia.I am pleased to present the revised clinical practise guidelines for dementia. In this regard the workgroup has performed a thorough review of the existing literature to recommend both pharmacological and nonpharmacological aspects of management for patients ranging from mild cognitive impairment to severe dementia. This revised guidelines also highlights issues related to the management of mild cognitive impairment, young onset dementia and e...

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Family Care as Collaboration: Effectiveness of a Multicomponent Support Program for Elderly Couples with Dementia. Randomized Controlled Intervention Study

Cited by 84 publications

References 47 publications

Barriers to Implementation of Case Management for Patients With Dementia: A Systematic Mixed Studies Review

Barriers to Implementation of Case Management for Patients With Dementia: A Systematic Mixed Studies Review

A Break-Even Analysis for Dementia Care Collaboration: Partners in Dementia Care

Systematic review of recent dementia practice guidelines

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