Background
Methods
Search strategy
1 | (case management ), key term |
2 | exp case management/or exp managed care program/ |
3 | (care management),key term |
4 | exp nursing care/or exp managed care program/or exp self care |
5 | 1 or 2 or 3 or 4 |
6 | ((care coordination) or (channeled care) or (care advocacy) or (care integration) or (integrated care) or (key worker) or (service broker) or (community matron) or linkage or brokerage), key term |
7 | 5 or 6 |
8 | (community care), key term |
9 | exp community networks/ |
10 | (respite care) , key term |
11 | exp respite care/ |
12 | (home care) , key term |
13 | exp foster home care/or exp home care services/or exp home nursing/ or home care agencies/ or home health aides/or exp patient-centered care/or exp delivery of health care, integrated |
14 | (long-term care ) , key term |
15 | exp long-term care/or exp insurance, long-term care |
16 | (home health) , key term |
17 | exp home care services/or home health aides/ |
18 | (social service*), key term |
19 | exp social welfare/ or social work/ |
20 | 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 |
21 | (community aged care) or (day care)or(home assistance) or (home help) or(in-home) or (community-based care) or (home-based care) or (aged care) or (senior care) or (elder* care) or (social care) , key term |
22 | 20 or 21 |
23 | 7 and 22 |
24 | limit 23 to ((English language; people aged 65 or over, or 80 or over; and human) |
25 | 23 and 24 |
Data extraction and synthesis
Quality assessment
Author | Overall quality | Methodology quality | ||||||
---|---|---|---|---|---|---|---|---|
Quality control | Randomization | Comparability | Follow-up rates | Dropout | Blinding assessor | Analysis | ||
Lam (2010) | High quality | + | + | + | 90.2% | + | + | + |
Yordi (1997) | Moderate quality | + | + | + | 34.0% | + | ? | ? |
Newcomer (1999) | Low quality | + | + | + | 36.0% | ? | ? | ? |
Applebaum (1988) | Low quality | ? | ? | ? | ? | ? | ? | ? |
Rabiner (1995) | Low quality | - | ? | ? | 100% | + | ? | ? |
Lowenstein (2000) | Moderate quality | + | + | + | 95.0% | + | ? | ? |
Eloniemi-Sulkava (2001) | Moderate quality | + | + | + | 52.0% | + | ? | ? |
Applebaum (2002) | Moderate quality | + | + | + | 82.9% | + | ? | ? |
Shapiro (2002) | Moderate quality | + | + | + | 50.0% | + | - | ? |
Challis (1985) | Low quality | + | - | + | 47.0% | + | ? | ? |
Marek (2006) | Low quality | + | - | + | 71.8% | + | - | ? |
Specht (2009) | Low quality | + | - | - | 34.9% | + | - | ? |
Onder (2007) | Low quality | + | - | - | 71.6% | + | - | ? |
Miller (1985) | Low quality | - | - | - | ? | ? | ? | ? |
Marshall, (1999) | Low quality | + | ? | - | 91.5% | + | - | ? |
Results
Author, year & location | Study design, study sample (mean age of older pepole X where applicable), sample size (N) & intervention length | Case management in community aged care interventions | Measurement instrument | Client outcomes | Carer outcomes |
---|---|---|---|---|---|
Yordi (1997) USA | RCT Older people with dementia Intervention/control: X=78.3/X=78.3; N= 2,707/N=2,547 3 years | Needs assessment, assisting carers arranging services, activating care plan & care quality monitoring. Intervention: smaller caseload (n=30) & higher monthly benefits ($430- $699 per client), control: larger caseload (n=100) & lower monthly benefits ($290- $489 per client) (the Alzheimer’s disease demonstration program). | Functional status: measured by a version of the Katz ADL & Lawton and Brody’s IADL scale at six-month intervals | Robust effect on reducing unmet needs with ADL/IADL tasks over time Significantly fewer unmet service needs in the intervention group during different follow-up periods | |
Newcomer (1999) USA | RCT Carers of older people with dementia Intervention/control: X=63/X=63; N=2,731/N=2,576 3 years | See [32]. | Burden: measured by an adapted scale developed by Zarit, Reever and Bach-Peterson Depression: measured by the short-form Geriatric Depression Scale | Burden: no significant intervention-control group differences during 6-, 12- or 36-month follow-up Depression: no significant intervention-control group differences during 12- or 36-month follow-up | |
Applebaum (1988) USA | RCT Older people (eligible for nursing home admission) & carers Intervention/control: N=1,861/N= 2,013 18 months | Needs assessment, care planning, service arrangement, monitoring, care plan modification & reassessment. Intervention: case managers having control over pooled funds; control: adopting a brokerage model (the Channeling Demonstration program). See [46] | Mortality rates Functioning: measured by an ADL five- item (eating, transfer, toileting, dressing, bathing & continence) scale, an IADL seven-item (housekeeping, meal preparation, shopping, transportation, taking medicine, financial management & telephone use) scale, and number of days restricted to bed Client social/psychological well-being: overall life satisfaction, morale, attitude towards to aging, social interactions, self-perceived health& overall contentment index Carer social/psychological well-being: life satisfaction & relationship with clients Carer stressors: perceived emotional/physical/financial strain & number of stressful behavior problems | No significant intervention-control group differences in mortality rates during different follow-up periods (first six months, 7–12 months & 12–18 months) Significantly higher life satisfaction, fewer number of unmet service needs & fewer number of ADL disabilities in the intervention group during different follow-up periods No significant intervention-control group differences in the number of IADL disabilities & number of days restricted to bed during different follow-up periods | Satisfaction with service arrangements improved significantly over time No significant intervention-control group differences in satisfaction, social well-being/psychological & stressor measures during different follow-up periods |
Rabiner (1995) USA | RCT People aged 65 and over Six-month analysis: N=2,237; 12-month analysis: N=1,726 (no details about the sample size of each group) 1 year | See [46] | Satisfaction: measured by extent of confidence (not confident, somewhat confident and very confident) in care at six- & 12-month follow-up | No significant intervention-control group difference in satisfaction during six-month follow-up Significantly greater satisfaction in the intervention group during 12-month follow-up | |
Lowenstein (2000) Israel | RCT People aged 69 and older (most of whom suffering from physical, cognitive and mental diseases) & carers Intervention/control: N=30/N=30 1 year | Referral, intake, needs assessment, care plan activation, care linkage, care plan modification, informal care support, monitoring, reassessment, evaluation & discharge arrangement. | Outcomes: reported by social workers through individual/group interviews at the end of the study | Significant improvements in community participation, satisfaction with services, consumer choice & unmet needs in the intervention group. | Significant improvements in satisfaction with services & burden in the intervention group. |
Eloniemi-Sulkava (2001) Finland | RCT People aged 65 and older with dementia Intervention/control: X=78.8/X=80.1; N=53/N= 47 2 years | Advocacy, counseling, annual training, follow-up calls, in-home visits, care arrangement & 24-hour services. | Year 1 &2 death rates | No significant intervention-control group differences in death rates during different follow-up periods | |
Applebaum (2002) USA | RCT Older people with disabilities Intervention/control: X=78.2/X=79.5; N=154/N= 154 18 months | Preventive activities (assessment & consumer training) & intervention activities (communication with physicians & hospital discharge planning). | Death rates & mean number of survival days by six, 12 and 18 months Functioning status: measured by average number of ADL disabilities (bathing, dressing, transfer from bed to chair, getting to the toilet, eating& inside mobility), average number of IADL disabilities & cognitive disorder (having Alzheimer/Dementia/ other cognitive or not) at different time points (baseline, six- & 12-month follow-up) Overall health status (range 0–16), overall health and service satisfaction (range 0–20): measured at different time points | No significant intervention-control group differences in death rates, mean number of survival days, service satisfaction, health status & physical functioning during different follow-up periods | |
Shapiro (2002) USA | RCT Older adults on waiting list to receive social care Intervention/control: X=77.8/X=76.9;N=40/N=65 18 months | Geriatric assessment subsequent service provision, care planning, care coordination & contacts per 3 months. | Nursing home admission/death rate by 18 months Quality of life (including depression, social satisfaction, mastery & life satisfaction): measured at three-month intervals | The intervention group was significantly less likely to die or be institutionalized Significantly better quality of life in the intervention group during different follow-up periods | |
Miller (1985) USA | Quasi-experimental study Low-income elderly medical people at risk of institutionalization Intervention/control: X=79/X=76.5 & N=1068/N=1495 in community group. X=77/X=76.1 & N=983/N=848 in hospital group. X=80.9/X=81.8 & N=261/N=196 in nursing home group. X=77.9/X=90 & N=607/N=28 in target group 2 years | A team of case managers providing multi-dimensional assessment, care planning, service arrangement, follow-up and reassessment | Number of days of life saved within one year and two years respectively | Significantly increased longevity among participants in the intervention group by 3.97 days in 1981, and 7.25 days 1982 Interventions were most effective for the frailest clients | |
Marshall, (1999) USA | RCT People aged 65 and over Intervention/control: X=81/X=82;N=159/N=160 2 years | Screening, selection, assessment, treatment plan, service arrangement within and outside the program & periodic reassessment | Functional status: measured by ADLs (bathing, eating, transferring, toileting &dressing rated from 1 to 3. higher score meant higher dependency level) and IADLs (needing telephoning, transportation, walking, & medication services or not) at baseline, year 1 & year 2 Perceived health status: measured on a scale of 1 to 4 defined as excellent, good, fair, or poor respectively at baseline, year 1 & year 2 Satisfaction with care: measured on a scale of 1 to 5 from very satisfied to very dissatisfied at baseline, year 1 & year 2 | During one-year follow-up: significantly improved perceived health status in the intervention group; control group was more satisfied with care; no significant intervention-control group differences in functional status measures During two-year study period: significantly better functional status in the intervention group Time effects: the intervention group did not experience significant changes in functional status or perceived health status during the whole study period compared with the control group | |
Lam (2010) Hongkong, China | RCT People aged 65 years old or above with mild dementia Intervention/control: X=78.6/X=78.2;N=59/N=43 18 months One year (with 4 months’ intervention) | Assessment and advice, home-based program on cognitive stimulation, liaising with other care professionals to ensure clients and carers’ participation in community activities | Carer stress: measured by Zarit Carer Burden Interview (ZBI) (22 items, specifically including perceived health, psychological well-being, financial impact, social life, and carer and client relationships) at three-month intervals (below is the same) Carer psychological health: measured by general health questionnaire (GHQ) Carer subjective quality of life: measured by personal well-being Index for Adults (PWI-As) Client cognitive status: measured by Mini Mental State Examination (CMMSE) Client psychiatric symptoms and behavioral disturbance: measured by The Neuropsychiatric Inventory (NPI) Client personal well-being: measured by the Personal Well-Being Index-Intellectual Disability (PWI-ID) Client depression: measured by Cornell Scale for Depression in Dementia (CSDD) | Significant improvement in client depression in the intervention group during 4-month follow up No significant intervention-control group differences in client cognitive status, client psychiatric symptoms and behavioral disturbances, or personal well-being during any study periods | No significant intervention-control group differences in carer stress, psychological health, or subjective quality of life during any study periods |
Challis (1985) England | Quasi-experiment Older people eligible for nursing home admission & carers Intervention/ control: N=74/N=74 3 years | Referrals, assessment, care planning, monitoring & case closure. | Death rates: measured at one-year intervals Client quality of life (morale, depressed mood, anxiety, loneliness & felt capacity to cope) & Carer outcomes (level of subjective burden; extent of strain; mental health difficulties; difficulties in social life, household routine, employment& financial issues): measured at the end of the study | No significant intervention-control group difference in death rate by 24 months; significantly lower death rate in the intervention group by 36 months. Significantly better quality of life (except anxiety) in the intervention group | Significantly lower level of burden in the intervention group No significant intervention-control group differences in the other carer outcomes |
Marek (2006b) USA | Quasi-experiment The frail elderly aged 64 and older Intervention/ control: N=55/N=30 1 year | Needs assessment, care plan reviewing, monitoring & hospital care coordination | Functioning status: measured by ADL (bed mobility, transfers, locomotion, eating & toileting. Each item scored from 0–4) score, cognitive performance scale (range 0–6) at different time points (baseline, six- & 12-month follow-up) Depression rating scale (range 0–2 for observed frequency of each of the seven mood indicators): measured at different time points Frequency of health outcomes measured at different time points: including incontinence (range 0–2), pain (range 0–3), dyspnea (range 0–4)& ability of medication management (range 0–1) | More death cases (6 vs.2) by 12 months in the intervention group. No significant intervention-control group differences in all client outcomes during six months Significantly better ADL performance, and less pain & dysnea in the intervention group during 12 months. | |
Specht (2009) USA | Quasi-experiment Older people with dementia & carer Intervention/control: X=82 .4/X=78.5;N=167/N=82 1.5 months | Needs identification and assessment, care plan development, home visits, monthly phone contacts, quarterly face-to-face contacts, periodic reassessment & care system coordination. | Outcomes of 3–9 months & 9–15 months were assessed Client functioning: measured by MMSE (range 1–30), GDS (range 1–7), functional Assessment II, Groff, R.L (range 1–3), modified IADL/ADL’s from Lawton and Brody (range 1–5) Client behaviors: measured by a rating checklist (Garrity and Klein) Client & carer health status: measured by SF-36 Carer well-being, stressors & endurance potential:measured by NOC (Moorehead et al.) | Significant decline in ADL abilities in the intervention group from baseline to each follow-up No significant intervention-control group differences in ADL disabilities, MMSE, GDS & behavior rating index during different follow-up periods. | Significantly lower stress, and better endurance potential & well-being in the intervention group during different follow-up periods |
Onder (2007) Italy | Retrospective cohort Frail elderly people Intervention/control: X=82 .1/X=82.5;N=1,184/N= 2,108 1 year | Initial assessment, monitoring, additional care provision, care plan design and implementation, care arrangement & care coordination. | 1-year mortality | No significant intervention-control group difference in 1-year mortality |