Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Int J Geriatr Psychiatry. 2013 Sep;28(9):889-902. doi: 10.1002/gps.3906. Epub 2012 Nov 27.
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.
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.
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.
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.
本研究旨在评估痴呆病例管理与常规护理相比，在减少痴呆成年患者的长期护理安置、住院和急诊就诊方面的效果。我们还试图评估这种干预对延迟长期护理安置和住院时间的效果。
我们检索了电子数据库，并补充了参考文献和会议记录，以寻找测试痴呆病例管理在减少社区中照护者-被照护者对生活的资源利用方面有效性的随机对照试验。我们对长期护理安置的风险比（RR）和加权均数差值以及住院入院率的 RR 进行了荟萃分析。汇总估计值进一步按研究特征和研究质量测量进行分层。
共有 17 项研究纳入荟萃分析。与常规护理相比，痴呆病例管理的总体 RR 为 0.94（95%置信区间[0.85, 1.03]；p=0.227）。按随访时间分层表明，随访时间小于 18 个月时，长期护理安置的风险显著降低（RR 0.61，95%置信区间[0.41, 0.91]，p=0.015）。痴呆病例管理与常规护理相比，其他结局没有效果。
痴呆病例管理在减少社区居住的老年痴呆症患者的长期护理安置风险方面显示出短期的积极效果。然而，其他资源利用来源和痴呆病例管理对长期护理安置风险的更广泛影响需要进一步研究。
