Table 3

Characteristics of studies included in the systematic review
Author, year & location Study design, study sample (mean age of older pepole X where applicable), sample size (N) & intervention length Case management in community aged care interventions Measurement instrument Client outcomes Carer outcomes
Yordi (1997) USA RCT Older people with dementia Intervention/control: X=78.3/X=78.3; N= 2,707/N=2,547 3 years Needs assessment, assisting carers arranging services, activating care plan & care quality monitoring. Intervention: smaller caseload (n=30) & higher monthly benefits ($430- $699 per client), control: larger caseload (n=100) & lower monthly benefits ($290- $489 per client) (the Alzheimer’s disease demonstration program). Functional status: measured by a version of the Katz ADL & Lawton and Brody’s IADL scale at six-month intervals Robust effect on reducing unmet needs with ADL/IADL tasks over time Significantly fewer unmet service needs in the intervention group during different follow-up periods
Newcomer (1999) USA RCT Carers of older people with dementia Intervention/control: X=63/X=63; N=2,731/N=2,576 3 years See [32]. Burden: measured by an adapted scale developed by Zarit, Reever and Bach-Peterson Depression: measured by the short-form Geriatric Depression Scale Burden: no significant intervention-control group differences during 6-, 12- or 36-month follow-up Depression: no significant intervention-control group differences during 12- or 36-month follow-up
Applebaum (1988) USA RCT Older people (eligible for nursing home admission) & carers Intervention/control: N=1,861/N= 2,013 18 months Needs assessment, care planning, service arrangement, monitoring, care plan modification & reassessment. Intervention: case managers having control over pooled funds; control: adopting a brokerage model (the Channeling Demonstration program). See [46] Mortality rates Functioning: measured by an ADL five- item (eating, transfer, toileting, dressing, bathing & continence) scale, an IADL seven-item (housekeeping, meal preparation, shopping, transportation, taking medicine, financial management & telephone use) scale, and number of days restricted to bed Client social/psychological well-being: overall life satisfaction, morale, attitude towards to aging, social interactions, self-perceived health& overall contentment index Carer social/psychological well-being: life satisfaction & relationship with clients Carer stressors: perceived emotional/physical/financial strain & number of stressful behavior problems No significant intervention-control group differences in mortality rates during different follow-up periods (first six months, 7–12 months & 12–18 months) Significantly higher life satisfaction, fewer number of unmet service needs & fewer number of ADL disabilities in the intervention group during different follow-up periods No significant intervention-control group differences in the number of IADL disabilities & number of days restricted to bed during different follow-up periods Satisfaction with service arrangements improved significantly over time No significant intervention-control group differences in satisfaction, social well-being/psychological & stressor measures during different follow-up periods
Rabiner (1995) USA RCT People aged 65 and over Six-month analysis: N=2,237; 12-month analysis: N=1,726 (no details about the sample size of each group) 1 year See [46] Satisfaction: measured by extent of confidence (not confident, somewhat confident and very confident) in care at six- & 12-month follow-up No significant intervention-control group difference in satisfaction during six-month follow-up Significantly greater satisfaction in the intervention group during 12-month follow-up
Lowenstein (2000) Israel RCT People aged 69 and older (most of whom suffering from physical, cognitive and mental diseases) & carers Intervention/control: N=30/N=30 1 year Referral, intake, needs assessment, care plan activation, care linkage, care plan modification, informal care support, monitoring, reassessment, evaluation & discharge arrangement. Outcomes: reported by social workers through individual/group interviews at the end of the study Significant improvements in community participation, satisfaction with services, consumer choice & unmet needs in the intervention group. Significant improvements in satisfaction with services & burden in the intervention group.
Eloniemi-Sulkava (2001) Finland RCT People aged 65 and older with dementia Intervention/control: X=78.8/X=80.1; N=53/N= 47 2 years Advocacy, counseling, annual training, follow-up calls, in-home visits, care arrangement & 24-hour services. Year 1 &2 death rates No significant intervention-control group differences in death rates during different follow-up periods
Applebaum (2002) USA RCT Older people with disabilities Intervention/control: X=78.2/X=79.5; N=154/N= 154 18 months Preventive activities (assessment & consumer training) & intervention activities (communication with physicians & hospital discharge planning). Death rates & mean number of survival days by six, 12 and 18 months Functioning status: measured by average number of ADL disabilities (bathing, dressing, transfer from bed to chair, getting to the toilet, eating& inside mobility), average number of IADL disabilities & cognitive disorder (having Alzheimer/Dementia/ other cognitive or not) at different time points (baseline, six- & 12-month follow-up) Overall health status (range 0–16), overall health and service satisfaction (range 0–20): measured at different time points No significant intervention-control group differences in death rates, mean number of survival days, service satisfaction, health status & physical functioning during different follow-up periods
Shapiro (2002) USA RCT Older adults on waiting list to receive social care Intervention/control: X=77.8/X=76.9;N=40/N=65 18 months Geriatric assessment subsequent service provision, care planning, care coordination & contacts per 3 months. Nursing home admission/death rate by 18 months Quality of life (including depression, social satisfaction, mastery & life satisfaction): measured at three-month intervals The intervention group was significantly less likely to die or be institutionalized Significantly better quality of life in the intervention group during different follow-up periods
Miller (1985) USA Quasi-experimental study Low-income elderly medical people at risk of institutionalization Intervention/control: X=79/X=76.5 & N=1068/N=1495 in community group. X=77/X=76.1 & N=983/N=848 in hospital group. X=80.9/X=81.8 & N=261/N=196 in nursing home group. X=77.9/X=90 & N=607/N=28 in target group 2 years A team of case managers providing multi-dimensional assessment, care planning, service arrangement, follow-up and reassessment Number of days of life saved within one year and two years respectively Significantly increased longevity among participants in the intervention group by 3.97 days in 1981, and 7.25 days 1982 Interventions were most effective for the frailest clients
Marshall, (1999) USA RCT People aged 65 and over Intervention/control: X=81/X=82;N=159/N=160 2 years Screening, selection, assessment, treatment plan, service arrangement within and outside the program & periodic reassessment Functional status: measured by ADLs (bathing, eating, transferring, toileting &dressing rated from 1 to 3. higher score meant higher dependency level) and IADLs (needing telephoning, transportation, walking, & medication services or not) at baseline, year 1 & year 2 Perceived health status: measured on a scale of 1 to 4 defined as excellent, good, fair, or poor respectively at baseline, year 1 & year 2 Satisfaction with care: measured on a scale of 1 to 5 from very satisfied to very dissatisfied at baseline, year 1 & year 2 During one-year follow-up: significantly improved perceived health status in the intervention group; control group was more satisfied with care; no significant intervention-control group differences in functional status measures During two-year study period: significantly better functional status in the intervention group Time effects: the intervention group did not experience significant changes in functional status or perceived health status during the whole study period compared with the control group
Lam (2010) Hongkong, China RCT People aged 65 years old or above with mild dementia Intervention/control: X=78.6/X=78.2;N=59/N=43 18 months One year (with 4 months’ intervention) Assessment and advice, home-based program on cognitive stimulation, liaising with other care professionals to ensure clients and carers’ participation in community activities Carer stress: measured by Zarit Carer Burden Interview (ZBI) (22 items, specifically including perceived health, psychological well-being, financial impact, social life, and carer and client relationships) at three-month intervals (below is the same) Carer psychological health: measured by general health questionnaire (GHQ) Carer subjective quality of life: measured by personal well-being Index for Adults (PWI-As) Client cognitive status: measured by Mini Mental State Examination (CMMSE) Client psychiatric symptoms and behavioral disturbance: measured by The Neuropsychiatric Inventory (NPI) Client personal well-being: measured by the Personal Well-Being Index-Intellectual Disability (PWI-ID) Client depression: measured by Cornell Scale for Depression in Dementia (CSDD) Significant improvement in client depression in the intervention group during 4-month follow up No significant intervention-control group differences in client cognitive status, client psychiatric symptoms and behavioral disturbances, or personal well-being during any study periods No significant intervention-control group differences in carer stress, psychological health, or subjective quality of life during any study periods
Challis (1985) England Quasi-experiment Older people eligible for nursing home admission & carers Intervention/ control: N=74/N=74 3 years Referrals, assessment, care planning, monitoring & case closure. Death rates: measured at one-year intervals Client quality of life (morale, depressed mood, anxiety, loneliness & felt capacity to cope) & Carer outcomes (level of subjective burden; extent of strain; mental health difficulties; difficulties in social life, household routine, employment& financial issues): measured at the end of the study No significant intervention-control group difference in death rate by 24 months; significantly lower death rate in the intervention group by 36 months. Significantly better quality of life (except anxiety) in the intervention group Significantly lower level of burden in the intervention group No significant intervention-control group differences in the other carer outcomes
Marek (2006b) USA Quasi-experiment The frail elderly aged 64 and older Intervention/ control: N=55/N=30 1 year Needs assessment, care plan reviewing, monitoring & hospital care coordination Functioning status: measured by ADL (bed mobility, transfers, locomotion, eating & toileting. Each item scored from 0–4) score, cognitive performance scale (range 0–6) at different time points (baseline, six- & 12-month follow-up) Depression rating scale (range 0–2 for observed frequency of each of the seven mood indicators): measured at different time points Frequency of health outcomes measured at different time points: including incontinence (range 0–2), pain (range 0–3), dyspnea (range 0–4)& ability of medication management (range 0–1) More death cases (6 vs.2) by 12 months in the intervention group. No significant intervention-control group differences in all client outcomes during six months Significantly better ADL performance, and less pain & dysnea in the intervention group during 12 months.
Specht (2009) USA Quasi-experiment Older people with dementia & carer Intervention/control: X=82 .4/X=78.5;N=167/N=82 1.5 months Needs identification and assessment, care plan development, home visits, monthly phone contacts, quarterly face-to-face contacts, periodic reassessment & care system coordination. Outcomes of 3–9 months & 9–15 months were assessed Client functioning: measured by MMSE (range 1–30), GDS (range 1–7), functional Assessment II, Groff, R.L (range 1–3), modified IADL/ADL’s from Lawton and Brody (range 1–5) Client behaviors: measured by a rating checklist (Garrity and Klein) Client & carer health status: measured by SF-36 Carer well-being, stressors & endurance potential:measured by NOC (Moorehead et al.) Significant decline in ADL abilities in the intervention group from baseline to each follow-up No significant intervention-control group differences in ADL disabilities, MMSE, GDS & behavior rating index during different follow-up periods. Significantly lower stress, and better endurance potential & well-being in the intervention group during different follow-up periods
Onder (2007) Italy Retrospective cohort Frail elderly people Intervention/control: X=82 .1/X=82.5;N=1,184/N= 2,108 1 year Initial assessment, monitoring, additional care provision, care plan design and implementation, care arrangement & care coordination. 1-year mortality No significant intervention-control group difference in 1-year mortality

You et al.

You et al. BMC Health Services Research 2012 12:395   doi:10.1186/1472-6963-12-395

Open Data