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Case management for caregivers of older adults with dementia

Public Health & Prevention: Home- or Family-based
  Literature review updated February 2018.

Case management for caregivers targets the informal caregivers of older adults that have dementia or Alzheimer’s disease (dementia/AD). These informal caregivers are typically the spouse or the adult child of the older adult with dementia/AD. Case management typically involves a standardized assessment, an individualized measurement-based treatment plan, and ongoing monitoring/reassessment of the plan. Case managers may provide education, coping strategies, and referrals to other services they identify as necessary to the caregiver based on the baseline and subsequent assessments (e.g., support groups, respite care, housekeeping). Case managers in the included studies were psychiatrists, home health aides, counselors, registered nurses, and social workers, and typically provided case management in one-on-one sessions in the home of the caregiver. On average, case management interventions in this analysis lasted for 12 months, with monthly check-ins by the case manager. Caregivers in the comparison groups receive the standardized assessment and usual referrals to other services.
 
ALL
META-ANALYSIS
CITATIONS

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the program impacts measured in the research literature (for example, impacts on crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases. See Estimating Program Effects Using Effect Sizes for additional information on how we estimate effect sizes.

The effect size may be adjusted from the unadjusted effect size estimated in the meta-analysis. Historically, WSIPP adjusted effect sizes to some programs based on the methodological characteristics of the study. For programs reviewed in 2024 or later, we do not make additional adjustments, and we use the unadjusted effect size whenever we run a benefit-cost analysis.

Research shows the magnitude of effects may change over time. For those effect sizes, we estimate outcome-based adjustments, which we apply between the first time ES is estimated and the second time ES is estimated. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Primary or secondary participant No. of effect sizes Treatment N Effect sizes (ES) and standard errors (SE) Unadjusted effect size (random effects model)
ES SE Age ES p-value
Major depressive disorder
Clinical diagnosis of major depression or symptoms measured on a validated scale.
 61 Primary 3 120 -0.215 0.320 61 -0.215 0.502
Caregiver burden
A measure of strain or stress for caregivers of older adults with dementia or Alzheimer's. Caregiver burden may include social, emotional, physical, or pratical stress or strain and is measured on a validated scale.
 61 Primary 3 120 -0.031 0.160 61 -0.031 0.845
Cognitive functioning
Measure of cognition in populations with dementia. Typically measured on a validated scale.
 68 Secondary 2 90 0.012 0.150 68 0.012 0.936

Citations Used in the Meta-Analysis

Chien, W.T., & Lee, I.Y.M. (2008). A disease management program for families of persons in Hong Kong with dementia. Psychiatric Services, 59I(4), 433-436.

Chien, W.T., & Lee, I.Y.M. (2011). Randomized controlled trial of a dementia care programme for families of home-resided older people with dementia. Journal of Advanced Nursing, 67(4), 774-787.

Dias, A., Dewey, M.E., D'Souza, J., Dhume, R., Motghare, D.D., Shaji, K.S., . . . Patel, V. (2008). The effectiveness of a home care program for supporting caregivers of persons with dementia in developing countries: A randomised controlled trial from Goa, India. Public Library of Science, 3(6), 1-7.

Fortinsky, R.H., Kulldorff, M., Kleppinger, A., & Kenyon-Pesce, L. (2009). Dementia care consultation for family caregivers: Collaborative model linking an Alzheimer's association chapter with primary care physicians. Aging & Mental Health, 13(2), 162-170.

Jansen, A.P., van Hout, H.P., Nijpels, G., Rijmen, F., Dröes, R.M., Pot, A.M., . . . van Marwijk, H.W.J. (2011). Effectiveness of case management among older adults with early symptoms of dementia and their primary informal caregivers: A randomized clinical trial. International Journal of Nursing Studies, 48(8), 933-43.