Evidence Summary

What is an Evidence Summary?

Key messages from scientific research that's ready to be acted on

Got It, Hide this
  • Rating:

Consumer-directed care can empower older people and their caregivers by offering them greater flexibility and by increasing their involvement in care-related decisions.

Ottmann G, Allen J, Feldman P  A systematic narrative review of consumer-directed care for older people: Implications for model development

Review question

  • What are older people’s preferences for and levels of satisfaction with consumer-directed care?


  • Consumer-directed care models give control over home-based care to consumers, and usually involve transferring cash or vouchers to enable them to make their own care choices and purchase the care they need. 
  • Consumer-directed care is becoming increasingly common, although approaches differ across countries.
  • Studies have found high levels of satisfaction with consumer-directed care, and that this approach can also reduce carer burden, although older adults have been found to be less interested in this type of care when compared to younger adults.

How the review was done

  • The review identified all relevant studies published from January 1992 to August 2011.
  • A total of 17 studies that focused on describing the perspectives of clients and caregivers about consumer-directed care strategies were included. 
  • The study was co-funded by the Helen Macpherson Smith Trust, Percy Baxter Charitable Trust, B.B. Hutchings Bequest, John William Fleming Trust and the Australian Research Council.

What the researchers found

  • Many older people want greater involvement in care-related decision-making, demand greater flexibility in spending their care allowances, and want more control in employing personal-care workers.
  • A broad range of personalized options should be available to older adults, as preferences for consumer-directed care programs vary widely depending on personal preferences and support needs, as well as social situations and where they live.
  • Older people may not have support from families and friends, which requires that social and community supports be developed with consumer-directed care programs.
  • Decision-making support and assistance with the range of administrative and accounting tasks related to consumer-directed care programs can increase older people’s acceptance of and readiness to enroll.
  • Flexible care options ranging from full self-direction to full support from case managers are needed to meet the diverse needs of older people.


  • Consumer-directed care has the potential to empower older people and their caregivers by offering them choice and flexibility and engaging them in care decisions, but these programs need to be personalized to meet the varying needs and preferences of older people.

Related Web Resources

  • Breast cancer: Risks and benefits, age 50-69

    Canadian Task Force on Preventive Health Care
    Your risk of dying from breast cancer is slightly reduced if you have regular screening. However, regular screening increases your chance of a false positive result, a biopsy and having part or all of a breast removed unnecessarily.
  • Breast cancer: Patient algorithm

    Canadian Task Force on Preventive Health Care
    The Canadian Task Force on Preventive Health Care recommends women between 50 and 74 years old who are not at high risk get screened for breast cancer every 2 to 3 years. Talk to your doctor about screening options if you are at high risk or over 74 years old.
  • Breast cancer: Patient FAQ

    Canadian Task Force on Preventive Health Care
    This resource includes frequently asked questions about breast cancer, including: Who is considered high risk? What are the harms associated with mammography? and Why is routine screening NOT recommended for women 40-49 years?
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Register for free access to all Professional content

Want the latest in aging research? Sign up for our email alerts.

Support for the Portal is largely provided by the Labarge Optimal Aging Initiative. AGE-WELL is a contributing partner. Help us to continue to provide direct and easy access to evidence-based information on health and social conditions to help you stay healthy, active and engaged as you grow older. Donate Today.

© 2012 - 2020 McMaster University | 1280 Main Street West | Hamilton, Ontario L8S4L8 | +1 905-525-9140 | Terms Of Use