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Do case managers help support people with dementia at home?

An NIHR programme reviewed published evidence on case management approaches. This is where a professional, such as a nurse, coordinates and actively manages care for individual patients. The review found thirteen trials, eleven of which involved carers.

The review showed some evidence that case management led to better outcomes for people with dementia and their carers - but the picture was mixed. For instance, there was some evidence from good quality studies that case management led to reduced admissions to care homes and overall healthcare costs in the medium term, but longer follow-up showed fewer benefits. There were uncertain impacts on patient depression or functional abilities.

Overall, it was quite difficult to extract actionable findings from the research. This is largely because of differences between studies in terms of the interventions and how they were measuring impact. As an example of the diversity of interventions studied, the case manager in the included studies varied from registered nurse, district nurse, nurse specialist, social worker, occupational therapist or psychiatrist. Studies came from Europe, Canada, US, India and Hong Kong. Only one study came from the UK, which limits the relevance given different ways of organising health services.

Although some of the findings are difficult to interpret because of their diversity, this review is helpful in describing the range of case management initiatives, their goals and outcomes.

The role of case managers in coordinating care and other kinds of home support are also being explored in current live NIHR studies, as well as important research in areas from managing sleep disturbance in people with dementia to the role of specialist nurses in supporting dementia carers.

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