Dementia case management and risk of long-term care placement: a systematic review and meta-analysis

Int J Geriatr Psychiatry. 2013 Sep;28(9):889-902. doi: 10.1002/gps.3906. Epub 2012 Nov 27.


Objectives: 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.

Conclusion: 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.

Keywords: caregivers; case management; dementia; emergency department visits; hospitalization; long-term care; meta-analysis; randomized controlled trials; resource utilization; systematic review.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Case Management*
  • Community Mental Health Services / methods*
  • Dementia / therapy*
  • Hospitalization / statistics & numerical data
  • Humans
  • Long-Term Care / statistics & numerical data*
  • Outcome and Process Assessment, Health Care / methods*
  • Randomized Controlled Trials as Topic