The potential of case management for people with dementia: a commentary
Article first published online: 22 FEB 2012
Copyright © 2012 John Wiley & Sons, Ltd.
International Journal of Geriatric Psychiatry
Volume 27, Issue 12, pages 1305–1314, December 2012
How to Cite
Koch, T., Iliffe, S., Manthorpe, J., Stephens, B., Fox, C., Robinson, L., Livingston, G., Coulton, S., Knapp, M., Chew-Graham, C., Katona, C. and CARE-DEM (2012), The potential of case management for people with dementia: a commentary. Int. J. Geriat. Psychiatry, 27: 1305–1314. doi: 10.1002/gps.3783
- Issue published online: 7 NOV 2012
- Article first published online: 22 FEB 2012
- Manuscript Accepted: 12 JAN 2012
- Manuscript Received: 22 JUL 2011
- case management;
- care coordination
A recent review of studies of case management in dementia argues that lack of evidence of cost-effectiveness should discourage the use of this approach to care. We argue that that this is too conservative a stance, given the urgent need throughout the world to improve the quality of care for people with dementia and their caregivers. We propose a research agenda on case management for people with dementia.
A critical comparison was made of the studies identified in two systematic reviews of trials of case management for dementia, with selective inclusion of non-trial studies and economic evaluations.
Our interpretation of the literature leads us to four provisional conclusions. First, studies with long follow-up periods tend to show delayed relocation of people with dementia to care homes. Second, the quality of life of people with dementia and their caregivers may also influence the likelihood of relocation. Third, different understandings of what constitutes case management make interpretation of studies difficult. Fourth, we agree that the population most likely to benefit from case management needs to be characterised. Earlier intervention may be more beneficial than intervening when the condition has progressed and the individual's situation is highly complex. However, this runs counter to some definitions of case management as an administrative, professional, and systemic focus on people with high needs and where expensive support is accessed or in prospect.
More work needs to be carried out in a more focused way in order to establish the value of case management for people with dementia. Since care home residence is such a sizeable contributor to the costs of dementia care, studies need to be long enough to capture possible postponed relocation. However, case management studies with shorter follow-up periods can still contribute to our understanding, since they can demonstrate improved quality of life. Future research should be built around a common, agreed definition of types of case management. Copyright © 2012 John Wiley & Sons, Ltd.