Journal Article

Effects of case management in community aged care on client and carer outcomes: a systematic review of randomized trials and comparative observational studies

Dunt, David, Doyle, Colleen, Hsueh, Arthur, You, Emily Chuanmei

2012

Overview

Background Case management has been applied in community aged care to meet frail older people’s holistic needs and promote cost-effectiveness. This systematic review aims to evaluate the effects of case management in community aged care on client and carer outcomes. Methods We searched Web of Science, Scopus, Medline, CINAHL (EBSCO) and PsycINFO (CSA) from inception to 2011 July. Inclusion criteria were: no restriction on date, English language, community-dwelling older people and/or carers, case management in community aged care, published in refereed journals, randomized control trials (RCTs) or comparative observational studies, examining client or carer outcomes. Quality of studies was assessed by using such indicators as quality control, randomization, comparability, follow-up rate, dropout, blinding assessors, and intention-to-treat analysis. Two reviewers independently screened potentially relevant studies, extracted information and assessed study quality. A narrative summary of findings were presented. Results Ten RCTs and five comparative observational studies were identified. One RCT was rated high quality. Client outcomes included mortality (7 studies), physical or cognitive functioning (6 studies), medical conditions (2 studies), behavioral problems (2 studies) , unmet service needs (3 studies), psychological health or well-being (7 studies) , and satisfaction with care (4 studies), while carer outcomes included stress or burden (6 studies), satisfaction with care (2 studies), psychological health or well-being (5 studies), and social consequences (such as social support and relationships with clients) (2 studies). Five of the seven studies reported that case management in community aged care interventions significantly improved psychological health or well-being in the intervention group, while all the three studies consistently reported fewer unmet service needs among the intervention participants. In contrast, available studies reported mixed results regarding client physical or cognitive functioning and carer stress or burden. There was also limited evidence indicating significant effects of the interventions on the other client and carer outcomes as described above. Conclusions Available evidence showed that case management in community aged care can improve client psychological health or well-being and unmet service needs. Future studies should investigate what specific components of case management are crucial in improving clients and their carers’ outcomes.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Aged, 80 and over / Caregivers / Case Management / Chronic illnesses / Clinical trials / Collaboration / Community aged care / Comparative analysis / Dementia / Effects / Elder care / Frailty / Health Administration / Health aspects / Health Informatics / Health Services for the Aged - organization & administration / Home health care / Humans / Integrated delivery systems / Intervention / Long term health care / Medical care / Medical case management / Medicine / Medicine & Public Health / Mental health / Nursing care / Nursing home care / Nursing Research / Observational studies / Observational Studies as Topic / Older people / Outcome Assessment, Health Care / Primary care / Psychological research / Public Health / Quality / Quality management / Randomized Controlled Trials as Topic / Research Article / Respite care / safety and outcomes / Social work / Studies / Systematic review