title: Dementia case management and risk of long-term care placement: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The objective of our study is to evaluate the effectiveness of dementia case management compared with usual care on reducing long-term care placement, hospitalization, and emergency department visits for adult patients with dementia. We also sought to evaluate the effectiveness of this intervention on delaying time to long-term care placement and hospitalization.
  
  
  METHODS
  We searched electronic databases supplemented by bibliographies and conference proceedings for randomized controlled trials testing the effectiveness of dementia case management in reducing resource utilization in a population of caregiver-care recipient dyads living in the community. We meta-analyzed the risk ratio (RR) and weighted mean differences of long-term care placement and the RR of hospital admissions. Pooled estimates were further stratified by study characteristics and measures of study quality.
  
  
  RESULTS
  Seventeen studies were included in the meta-analysis. The overall pooled RR of long-term care placement was 0.94 (95% confidence interval [0.85, 1.03]; p = 0.227) for dementia case management compared with usual care. Stratification by follow-up duration indicated a statistically significant reduction in risk of long-term care placement when follow-up duration was less than 18 months (RR 0.61, 95% confidence interval [0.41, 0.91], p = 0.015). There was no effect of dementia case management compared with usual care for the other outcomes.
  
  
  CONCLUSIONS
  Dementia case management demonstrated a short-term positive effect on reducing the risk of long-term care placement among older people with dementia residing in the community. However, other sources of resource utilization and more extended effects of dementia case management on risk of long-term care placement warrant further investigation.
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Helen
authors.initials: H
authors.lastname: Tam-Tham
authors.forename: Monica
authors.initials: M
authors.lastname: Cepoiu-Martin
authors.forename: Paul E
authors.initials: PE
authors.lastname: Ronksley
authors.forename: Colleen J
authors.initials: CJ
authors.lastname: Maxwell
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
mesh_terms: D019090:Case Management; D003156:Community Mental Health Services / Q000379:methods*; D003704:Dementia / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic