title: Effectiveness of case management among older adults with early symptoms of dementia and their primary informal caregivers: a randomized clinical trial.
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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  Randomized controlled trial with measurements at baseline and after 6 and 12 months.
  
  
  METHODS
  Primary care in West-Friesland, the Netherlands.
  
  
  METHODS
  99 pairs of community-dwelling older adults with dementia symptoms (defined as abnormal screening for symptoms of dementia) and their primary informal caregivers.
  
  
  METHODS
  12 months of case management by district nurses for both older adults and informal caregivers versus usual care.
  
  
  METHODS
  
  
  
  METHODS
  informal caregiver's sense of competence.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General Practice, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. d.jansen@vumc.nl
authors.forename: Aaltje P D
authors.initials: AP
authors.lastname: Jansen
authors.forename: Hein P J
authors.initials: HP
authors.lastname: van Hout
authors.forename: Giel
authors.initials: G
authors.lastname: Nijpels
authors.forename: Frank
authors.initials: F
authors.lastname: Rijmen
authors.forename: Rose-Marie
authors.initials: RM
authors.lastname: Dröes
authors.forename: Anne-Margriet
authors.initials: AM
authors.lastname: Pot
authors.forename: François G
authors.initials: FG
authors.lastname: Schellevis
authors.forename: Wim A B
authors.initials: WA
authors.lastname: Stalman
authors.forename: Harm W J
authors.initials: HW
authors.lastname: van Marwijk
mesh_terms: D000368:Aged; D017028:Caregivers; D019090:Case Management / Q000592:standards*; D003704:Dementia / Q000451:nursing*; D006801:Humans; D009426:Netherlands