Mapping of Components of Case Management to Needs and Their Effects on the Needs
| Categories of Need | Corresponding Components of Case Management | Resultant Effects |
|---|---|---|
| Needs of the patient/caregiver dyad | ||
| Early diagnosisa | Gathering information through the basic diagnostic battery to help family physicians establish a diagnosis21,22 | Dementia diagnosis increased in primary care while remaining stable in specialty care21,22 |
| Education/counseling on disease | Holding interactive seminars and family meetings for patients and caregivers on relevant care issues16,17 Providing information by phone to caregivers17,18 Helping the patient and family understand the disease, prognosis, and rationale of treatment19,21,22 Exploring problematic home care situations18 | Caregivers understood medical treatment for behavior and depression: 78.4% vs 72.2% in usual care (P = .49)6 Perception of caregiver’s clarity in discussing patient’s care: 16.8% vs 21.3% of usual care (P = .01)16 100% of caregivers were satisfied with the ability of case managers to answer questions15 Educational material was relevant to the dyad situation in 95% of cases15 95% of caregivers were satisfied with quality of educational material provided15 A majority of caregivers were satisfied with information allowing them to understand the nature of the disease20 Caregiver knowledge about dementia was not improved (P = .19)16 |
| Information on relevant services | Recommending caregiver resources—eg, Alzheimer’s Association, meals on wheels, and Safe Return program (for wandering)16 Helping with various services (day care, respite care)20 | 97% of caregivers were satisfied with the information they received on community resources15 Caregivers were more aware of dementia-specific resources20 |
| Help with legal issues | Educating caregivers on legal issues14,15 | Not evaluated |
| Financial support and planning | Educating caregivers on dementia-related financial planning14–16 | Not evaluated |
| Advance care planning | Advising on advance directives16 Interactive seminars for caregivers on evaluation of decision-making capacity16 | With CM, advance directives were discussed or completed and documented in 69.4% of cases, vs 44.4% in usual care (P = .001)16 Decision-making capacity improved in 34.2% of patients vs 9.7% in usual care (P = .001)16 90% of caregivers were satisfied with future planning15 |
| Care coordination, continuity of care, and a well-defined care pathway | Communicating regularly with family physicians,14,15,17,19 maintaining written consultation notes,14,16 producing secure electronic updates,15 via web-based systems,14,16 and attending case conferences14,20 Connecting patients and their caregivers to support services16,17,19 Operating in conjunction with any services patient already had20 | 70% to 82.8% of caregivers rated a new way of primary care delivery as very good/excellent14 88% of caregivers were satisfied with the care coordination provided17 100% of caregivers stated that intervention was efficient17 95% of caregivers were satisfied with the ability of case managers to link them with community resources15 The quality of patient’s health care improved (P = .003)16 1 study found no difference in interdisciplinary communication between intervention and usual care group (P = .5)18 |
| Access to health care professionals trained in geriatrics | Case managers are trained in geriatrics/geropsychiatry,14–18,20 communicating the diagnosis to the families,14 skills in communicating with patients and their caregivers,17 dementia home care18 Involving a multidisciplinary team in patient care (eg, geriatrician, geriatric psychiatrist, and psychologist)14 Helping with access to health care professionals19 Referring to specialists if needed17,21,22 | Not evaluated |
| Access to family physician trained in geriatrics | No prior formal training of family physicians in geriatrics | Not evaluated |
| Needs of the patient | ||
| Meaningful activities | Providing patient exercise guidelines and resources (eg, group chair-based exercises)14,15 | Not evaluated |
| Assistance with ADL/IADL | Advising on implementation of predictable routine of daily activities16 Providing nonpharmacologic protocols that include mobility management, personal care concerns14,15 | No effect14,18 |
| Behavior management | Arranging interactive seminars for caregivers on evaluation of acute behavior changes16 Providing specific protocols and nonpharmacologic interventions for repetitive behavior, agitation, aggression, delusions or hallucinations14–16 Providing drug therapy with anticholinesterase inhibitors and memantine14,16,21,22 | 47.2% Received as much help as needed with behavioral problems vs 29% in usual care (P = .01)16 The rate of antidementia medication prescription by family physicians was increased from 42% to 86% and the rate of neuroleptic prescription decreased21,22 |
| Cognition management | Assessing patients’ memory regularly14–16 Educating on communication14 and applying nonpharmacologic protocols that include communication techniques15 | No effect14 |
| Management of mood swings/depression | Providing a specific protocol of nonpharmacologic interventions on depression, with drug therapy as a backup14,15 Arranging interactive seminars for caregivers on managing depression in patients16 | No effect14,18 |
| Safety | Making recommendations on home safety and the Safe Return program (for wandering)16 Providing personal alarms18 Assessing the patient’s home situation19 Guiding the caregiver in organizing home care18 | 27.3% of patients were enrolled in Safe Return vs 8.4% in usual care (P = .001)16 |
| Needs of the caregiver | ||
| Emotional support | Providing support sessions focused on caregiver stress14,17; Recommending nonpharmacologic protocols that includes stress management15 | In 2 studies, caregiver mood improved at 12 months (P = .03)14,18; another found no effect at 18 months(P = .33)14 Caregiver burden was not affected (P = .49)17,18 |
| Social support | Recommending a caregiver support group16; Organizing family meetings aimed at improving social support and relieving the primary caregiver17,21,22 | Caregivers’ support systems were adequate in 80.4% of cases vs 45% in usual care (P = .001)16 40.7% of caregivers received services vs 19.2% in usual care (P = .002)16 Caregivers were socially supported (P = .03)16 |
| In-home support | Helping with home care,17,18 meals on wheels,16 and dinner services17 | 38.7% of caregivers received in-home help vs 28.9% in usual care (P = .02)16 100% of caregivers were satisfied with home help17 |
| Capacity to provide care | Educating caregivers on coping skills14 | Caregiver confidence and mastery were greater in CM (P = .001)16 |
| Involvement in care planning | Involving caregivers in individualized care plan and problem list development14–18,20–22 | 38.2% of caregivers were involved in care plan development vs 22.1% in usual care (P = .001)16 In 82.5% of cases, caregiver gave input on behavior issues vs 39% in usual care (P = .001)16 96% of caregivers were satisfied with discussion of patient’s health problems17 |
ADL = activities of daily life; CM = case management; IADL = instrumental activities of daily living
↵a Only 1 of the studies on CM interventions enrolled patients not already diagnosed with dementia.21