Case management in community-based care for older adults can improve patients’ psychological health and reduce their unmet service needs

You E, Dunt D, Doyle C, et al.  Effects of case management in community aged care on client and carer outcomes: A systematic review of randomized trials and comparative observational studies  BMC Health Services Research. 2012;12:395.

Review question

What are the effects of case management in community-based care for older adults on patients and informal/family caregivers?

Background

Community-based care refers to health-related care and support provided to older adults living in the community (for example, at home or in a retirement home).Case management usually includes:

• providing a range of services for those with chronic and complex health conditions, and age-related disabilities (for example, dementia);
• providing services for the long-term or in intense, short periods before placement in a residential aged care facility; and
• collaborating with the informal/family caregiver.

How the review was done

The review aimed to identify all relevant studies published before July 2011.

15 studies were included, all based on pilot programs targeting older adults with some age-related health problems (such as functional disabilities and dementia) living in the community, and/or their informal/family caregivers.

The funding source for this review was not provided.

What the researchers found

Case management interventions generally included assessment, care planning and implementation, care coordination, monitoring and re-assessment.

Interventions specifically targeting people with dementia and their family caregivers included education and counselling services, caregiver training, medical treatment and medication management, crisis interventions, patient empowerment and patient advocacy.

Case management significantly improved patients’ psychological health and well-being.

Patients consistently reported fewer unmet service needs after receiving case management.

There is mixed evidence regarding the effect of case management on patients’ physical or cognitive functioning and caregivers’ stress or burden.

There is limited evidence to support the use of case management for improving other outcomes (e.g. patients’ length of survival, health, behavioural problems, satisfaction with care, as well as caregivers’ psychological health or well-being and social consequences).

Conclusion

Case management in community care for the aged showed some benefits, but it remains unclear which specific components are crucial.

Main findings