title: Effectiveness of nonpharmacological interventions in delaying the institutionalization of patients with dementia: a meta-analysis.
abstract: Contemporary healthcare policies are designed to shape the conditions that can help delay the institutionalization of patients with dementia. This can be done by developing support programs that minimize healthcare risks for the patients with dementia and their informal caregivers. Many support programs have been developed, and some of them are effective, but there has been no systematic review with a meta-analysis of all types of nonpharmacological support programs with odds of institutionalization or time to institutionalization as an outcome measure. A systematic review with a meta-analysis was therefore conducted to estimate the overall effectiveness of nonpharmacological support programs for caregivers and patients with dementia that are intended to delay institutionalization. Thirteen support programs with a total of 9,043 patients were included in the meta-analyses. The estimated overall effectiveness suggests that these programs significantly decrease the odds of institutionalization (odds ratio (OR)=0.66, 95% confidence interval (CI)=0.43-0.99, P=.05) and significantly increase the time to institutionalization (standardized mean difference (SMD)=1.44, 95% CI=0.07-2.81, P=.04). A meta-analysis of the best-quality studies still showed a positive significant result for the odds of institutionalization (OR=0.60, 95% CI=0.43-0.85, P=.004), although the time to institutionalization was no longer significant (SMD=1.55, 95% CI=-0.35- 3.45, P=.11). The analysis of the intervention characteristics showed that actively involving caregivers in making choices about treatments distinguishes effective from ineffective support programs. Further investigation should be directed toward calculating the potential efficiency of these support programs by applying net-benefit or cost-effectiveness analysis.
authors.affiliation: Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. A.Spijker@kwazo.umcn.nl
authors.forename: Anouk
authors.initials: A
authors.lastname: Spijker
authors.forename: Myrra
authors.initials: M
authors.lastname: Vernooij-Dassen
authors.forename: Emmelyne
authors.initials: E
authors.lastname: Vasse
authors.forename: Eddy
authors.initials: E
authors.lastname: Adang
authors.forename: Hub
authors.initials: H
authors.lastname: Wollersheim
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
authors.forename: Frans
authors.initials: F
authors.lastname: Verhey
mesh_terms: D000368:Aged; D001315:Australia; D017028:Caregivers; D003704:Dementia / Q000628:therapy*; D019468:Disease Management; D005060:Europe; D006801:Humans; D009656:North America; D012944:Social Support; D016896:Treatment Outcome