Dementia case management and risk of long-term care placement: a systematic review and meta-analysis

作者：Tam Tham Helen; Cepoiu Martin Monica; Ronksley Paul E; Maxwell Colleen J; Hemmelgarn Brenda R^*

来源：International Journal of Geriatric Psychiatry, 2013, 28(9): 889-902.

DOI：10.1002/gps.3906

• dementia
• case management
• caregivers
• long-term care
• hospitalization
• meta-analysis
• systematic review
• resource utilization
• emergency department visits
• randomized controlled trials

Objectives: The objective of our study is to evaluate the effectiveness of dementia case management compared with usual care on reducing long-term care placement, hospitalization, and emergency department visits for adult patients with dementia. We also sought to evaluate the effectiveness of this intervention on delaying time to long-term care placement and hospitalization. %26lt;br%26gt;Methods: We searched electronic databases supplemented by bibliographies and conference proceedings for randomized controlled trials testing the effectiveness of dementia case management in reducing resource utilization in a population of caregiver-care recipient dyads living in the community. We meta-analyzed the risk ratio (RR) and weighted mean differences of long-term care placement and the RR of hospital admissions. Pooled estimates were further stratified by study characteristics and measures of study quality. %26lt;br%26gt;Results: Seventeen studies were included in the meta-analysis. The overall pooled RR of long-term care placement was 0.94 (95% confidence interval [0.85, 1.03]; p = 0.227) for dementia case management compared with usual care. Stratification by follow-up duration indicated a statistically significant reduction in risk of long-term care placement when follow-up duration was less than 18 months (RR 0.61, 95% confidence interval [0.41, 0.91], p = 0.015). There was no effect of dementia case management compared with usual care for the other outcomes. %26lt;br%26gt;Conclusion: Dementia case management demonstrated a short-term positive effect on reducing the risk of long-term care placement among older people with dementia residing in the community. However, other sources of resource utilization and more extended effects of dementia case management on risk of long-term care placement warrant further investigation.

• 出版日期2013-9