Effectiveness of case management among older adults with early symptoms of dementia and their primary informal caregivers: A randomized clinical trial

doi:10.1016/j.ijnurstu.2011.02.004

International Journal of Nursing Studies

Volume 48, Issue 8, August 2011, Pages 933-943

https://doi.org/10.1016/j.ijnurstu.2011.02.004 Get rights and content

Abstract

Background

It is believed that timely recognition and diagnosis of dementia is a pre-condition for improving care for both older adults with dementia and their informal caregivers. However, diagnosing dementia often occurs late in the disease. This means that a significant number of patients with early symptoms of dementia and their informal caregivers may lack appropriate care.

Objectives

To compare the effects of case management and usual care among community-dwelling older adults with early symptoms of dementia and their primary informal caregivers.

Design

Randomized controlled trial with measurements at baseline and after 6 and 12 months.

Setting

Primary care in West-Friesland, the Netherlands.

Participants

99 pairs of community-dwelling older adults with dementia symptoms (defined as abnormal screening for symptoms of dementia) and their primary informal caregivers.

Intervention

12 months of case management by district nurses for both older adults and informal caregivers versus usual care.

Measurements

Primary outcome: informal caregiver's sense of competence. Secondary outcomes: caregiver's quality of life, depressive symptoms, and burden, and patient's quality of life. Process measurements: intervention fidelity and caregiver's satisfaction with the quality of case management.

Results

Linear mixed model analyses showed no statistically significant and clinically relevant differences over time between the two groups. The process evaluation revealed that intervention fidelity could have been better. Meanwhile, informal caregivers were satisfied with the quality of case management.

Conclusion

This study shows no benefits of case management for older adults with dementia symptoms and their primary informal caregivers. One possible explanation is that case management, which has been recommended among diagnosed dementia patients, may not be beneficial if offered too early. However, on the other hand, it is possible that: (1) case management will be effective in this group if more fully implemented and adapted or aimed at informal caregivers who experience more severe distress and problems; (2) case management is beneficial but that it is not seen in the timeframe studied; (3) case management might have undetected small benefits. This has to be established.

Trial registration ISCRTN83135728.

Section snippets

Background

The growing number of older adults with dementia and its associated increasing health care utilization are experienced as problems worldwide, as well as the prevalent adverse financial, physical, social, and psychological consequences for the informal caregivers (Torti et al., 2004).

It is believed that timely recognition and diagnosis of dementia is a pre-condition for improving care for both older adults with dementia and their caregivers (Vernooij-Dassen et al., 2005). However, diagnosing

Design

A randomized controlled trial was conducted with random assignment of participants to either case management by district nurses or usual care. Potential participants were sent an information letter by mail and were asked to sign an informed consent form. In case people were incompetent their representatives were asked to give informed consent. The Medical Ethics Committee of the VU University medical center in Amsterdam approved the study protocol. The study protocol has been described

Participants

Between February 2004 and June 2005, 99 pairs of informal caregivers and care recipients were enrolled in the study in three ways:

(1)
72 care recipients, aged 75 years or older, were identified by means of the IQCODE sent by their PCP and subsequent cognitive testing;
(2)
7 care recipients, aged 75 years or older, were suspected of dementia by their PCP and identified by subsequent cognitive testing. They had not responded to the IQCODE or they had responded but were not identified by means of the

Discussion

This study shows no benefits of case management for older adults with dementia symptoms and their primary caregivers.

Acknowledgements

The authors like to thank all participating older adults and their informal caregivers, the nurses, the PCPs, the interviewers, the research-assistants Willemijn Tybout, Evelyn Mulder and Paulien Hoekstra, and Home Care Organization ‘De Omring’ for their cooperation.

Conflict of interest: None declared.

Funding: The Netherlands Organisation for Health Research and Development (ZonMw) kindly supported this study (ZonMw Grant No. 2200.0114). We proposed the study to ZonMw, and after that, the

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View full text

Effectiveness of case management among older adults with early symptoms of dementia and their primary informal caregivers: A randomized clinical trial

Abstract

Background

Objectives

Design

Setting

Participants

Intervention

Measurements

Results

Conclusion

Section snippets

Background

Design

Participants

Discussion

Acknowledgements

J. Psychiatr. Res.

Soc. Sci. Med.

J. Affect. Disord.

Alzheimer in Europe Yearbook 2008

Interventions to reduce the burden of caregiving for an adult with dementia: a meta-analysis

Res. Nurs. Health

An English language version of the social support list: preliminary reliability

Psychol. Rep.

Conceptualization and measurement of quality of life in dementia: the dementia quality of life instrument (DQoL)

The Gerontologist

Meta-analysis of psychosocial interventions for caregivers of people with dementia

J. Am. Geriatr. Soc.

Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial

JAMA

Care management, dementia care and specialist mental health services: an evaluation

Int. J. Geriatr. Psychiatry

Interventions to improve quality of care: the Kaiser Permanente-Alzheimer's Association Dementia Care Project

Am. J. Manag. Care

Applied Longitudinal Analysis

(Cost)-effectiveness of case-management by district nurses among primary informal caregivers of older adults with dementia symptoms and the older adults who receive informal care: design of a randomized controlled trial [ISCRTN83135728]

BMC Public Health

The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms

Psychol. Med.

Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory

J. Neuropsychiatry Clin. Neurosci.

Capacity and burden questionnaire for primary caregivers

Minimum data set for home care: a valid instrument to assess frail older people living in the community

Med. Care

The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs

Med. Care