title: A systematic review of different models of home and community care services for older persons.
abstract: BACKGROUND
  Costs and consumer preference have led to a shift from the long-term institutional care of aged older people to home and community based care. The aim of this review is to evaluate the outcomes of case managed, integrated or consumer directed home and community care services for older persons, including those with dementia.
  
  
  METHODS
  A systematic review was conducted of non-medical home and community care services for frail older persons. MEDLINE, PsycINFO, CINAHL, AgeLine, Scopus and PubMed were searched from 1994 to May 2009. Two researchers independently reviewed search results.
  
  
  RESULTS
  Thirty five papers were included in this review. Evidence from randomized controlled trials showed that case management improves function and appropriate use of medications, increases use of community services and reduces nursing home admission. Evidence, mostly from non-randomized trials, showed that integrated care increases service use; randomized trials reported that integrated care does not improve clinical outcomes. The lowest quality evidence was for consumer directed care which appears to increase satisfaction with care and community service use but has little effect on clinical outcomes. Studies were heterogeneous in methodology and results were not consistent.
  
  
  CONCLUSIONS
  The outcomes of each model of care differ and correspond to the model's focus. Combining key elements of all three models may maximize outcomes.
authors.affiliation: Dementia Collaborative Research Centre, School of Psychiatry, Faculty of Medicine, AGSM Building, University of NSW, Sydney NSW 2052 Australia. lf.low@unsw.edu.au
authors.forename: Lee-Fay
authors.initials: LF
authors.lastname: Low
authors.forename: Melvyn
authors.initials: M
authors.lastname: Yap
authors.forename: Henry
authors.initials: H
authors.lastname: Brodaty
mesh_terms: D000367:Age Factors; D000375:Aging; D001315:Australia; D019090:Case Management / Q000706:statistics & numerical data*; D003153:Community Health Services / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data; D008962:Models, Theoretical; D017063:Outcome Assessment, Health Care