| Author, year | Title | Type of source/study design (where applicable) | Geographic location | Setting | Delivery format | Population/condition | Team composition | Navigator title |
|---|---|---|---|---|---|---|---|---|
| Amjad et al.,32 2018 | Health services utilization in older adults with dementia receiving care coordination: the MIND at Home trial | Randomized controlled trial | Baltimore, Maryland, US | Home and community | Phone and in person | 70 years and older, English-speaking, community residing in northwest Baltimore (28 postal codes), with a reliable study partner (ie, dyad); met Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria for dementia or cognitive disorder not otherwise specified, and had one or more unmet care needs on the Johns Hopkins Dementia Care Needs Assessment | Interdisciplinary team of nonclinical memory care coordinators linked to a registered nurse and a geriatric psychiatrist | Care coordinator |
| Bass et al.,59 2003 | The Cleveland Alzheimer’s managed care demonstration: outcomes after 12 months of implementation | Randomized controlled trial | Cleveland, Ohio, US | Home and community | Phone | People with memory problems and people with dementia (pre-diagnosis); 55 years and older; living in the community | Lay team of care consultants and trained volunteers | Care consultant |
| Bass et al.,45 2013 | Caregiver outcomes of Partners in Dementia Care: effect of a care coordination program for veterans with dementia and their family members and friends | Quasi-experimental study (participants were not randomized to intervention or control) | US (Boston, Massachusetts; Providence, Rhode Island; Houston, Texas; Oklahoma City, Oklahoma; and Beaumont, Texas) | Home and community (based out of a Veterans Affairs center) | Phone, email, and mail | Veterans with dementia (aged 50 years and older) and their caregivers | Interdisciplinary team of care coordinators from Veterans Affairs and Alzheimer’s Association | Care coordinator |
| Bass et al.,46 2014 | A controlled trial of Partners in Dementia Care: veteran outcomes after six and twelve months | Randomized controlled trial | 5 regions in the US | Home and community (based out of a Veterans Affairs center) | Phone, email, mail, and in person | Veterans with dementia and their caregivers | Interdisciplinary team of care coordinators from Veterans Affairs and Alzheimer’s Association with administrative support | Care coordinator |
| Bass et al.,47 2015 | Impact of the care coordination program “Partners in Dementia Care” on veterans’ hospital admissions and emergency department visits | Randomized controlled trial | US (Boston, Massachusetts; Providence, Rhode Island; Houston, Texas; Oklahoma City, Oklahoma; and Beaumont, Texas) | Home and community | Phone, email, and mail | Veterans with dementia and their caregivers | Interdisciplinary team of care coordinators from Veterans Affairs and Alzheimer’s Association | Care coordinator |
| Bernstein et al.,22 2019 | The role of care navigators working with people with dementia and their caregivers | Qualitative exploratory study | California, Nebraska, and Iowa, US | Home and community | Phone and web-based | Dyads made up of people with dementia and their caregivers; with a diagnosis, speaking English, Spanish, or Cantonese | Interdisciplinary team of care team navigators, advanced practice clinical nurse, a social worker, and a pharmacist | Care team navigator |
| Bernstein et al.,39 2020 | Using care navigation to address caregiver burden in dementia: a qualitative case study analysis | Qualitative exploratory study | California and Nebraska, US | Home and community (based out of urban academic health centers) | Phone and web-based | Dyads made up of people with dementia and their caregivers; with a diagnosis, speaking English, Spanish, or Cantonese | Interdisciplinary team of care team navigators, advanced practice clinical nurse, a social worker, and a pharmacist | Care team navigator |
| Chen et al.,55 2020 | Effect of care coordination on patients with Alzheimer disease and their caregivers | Quasi-experimental study | Greenville, South Carolina, US | N/A | N/A | People with dementia and their caregivers | Interdisciplinary team included care coordinator and licensed social worker | Care coordinator |
| Dang et al.,57 2008 | Care coordination assisted by technology for multiethnic caregivers of persons with dementia: a pilot clinical demonstration project on caregiver burden and depression | Qualitative study | Miami, Florida, US | Home and community | Phone | Home-dwelling veterans over the age of 60 years, with a diagnosis of dementia or related disorders; caregivers were required to live with the veteran | Interdisciplinary team of nurse care coordinator and a support person, who also communicated with the care recipients’ providers | Care coordinator |
| Dementia Waikato,66 2017 | Dementia navigator service | Brochure | Waikato, New Zealand | Home and community | Phone and in person | People with dementia and caregivers, residing in the Waikato District Health Board area, dementia diagnosis required, must be eligible for public health services | Interdisciplinary team of registered nurses, occupational therapists, social workers, and dementia navigator | Support coordinator |
| Department of Veterans Affairs,67 2020 | Rural Interdisciplinary Team Training (RITT) dementia care coordinator program | Information sheet | US | Home and community | Phone and email | Caregivers of veterans with dementia | Interdisciplinary team of licensed clinical social workers and volunteers | Dementia care coordinator |
| Fæø et al.,53 2020 | The compound role of a coordinator for home-dwelling persons with dementia and their informal caregivers: qualitative study | Qualitative study | Norway | Home and community | Phone and in person | Dyads made up of people with dementia and their care partners, who lived at home | Clinical team of 2 specialist nurses acting as coordinators | Coordinator |
| Fortinsky et al.,65 2002 | Helping family caregivers by linking primary care physicians with community-based dementia care services: the Alzheimer’s Service Coordination Program | Mixed methods | Cleveland, Ohio, US | Home and community | Phone and in person | People with dementia and their caregivers | N/A | Service coordinator |
| Galik and Stefanacci,69 2019 | Improving care for patients with dementia: what to do before, during, and after a transition | Editorial | US | Home and community | N/A | People with dementia and their caregivers | Interdisciplinary team | Alzheimer’s patient navigation |
| Galvin et al.,56 2014 | Public–private partnerships improve health outcomes in individuals with early-stage Alzheimer’s disease | Cross-sectional, non-randomized research study | Missouri, US | Home and community | Phone and in person | People with dementia and their caregivers, diagnosis required | Interdisciplinary team of New York University researchers, the Missouri Department of Health and Senior Services, Area Agencies on Aging, and local Alzheimer’s Association Chapters | Project Learn MORE (Missouri Outreach and Referral Expanded) coordinator |
| Goeman et al.,63 2016 | Development of a model of dementia support and pathway for culturally and linguistically diverse communities using co-creation and participatory action research | Qualitative study using a co-creation and participatory action research approach | Australia | Home and community | Phone and in person | Culturally and linguistically diverse community members with cognitive impairment living in the community and their family or caregiver | Clinical team of nurses | Specialist dementia nurse |
| Husebo et al.,54 2020 | LIVE@Home.Path—innovating the clinical pathway for home-dwelling people with dementia and their caregivers: study protocol for a mixed methods, stepped-wedge, randomized controlled trial | Study protocol | 3 municipalities in Norway | Home and community | Phone and in person | Dyads made up of people with dementia and their care partners, who lived at home | Clinical team of 2 specialist nurses, acting as coordinators | Coordinator |
| Joels and van Pol,51 2014 | How to manage follow-up patients: Dementia Navigators | Report/presentation slides | Islington borough of London, UK | Home and community | Phone and in person | People with dementia and their informal caregivers | Interdisciplinary team of a full-time team leader with clinical and managerial responsibilities and 3 dementia navigators | Dementia navigator |
| Judge et al.,48 2011 | Partners in Dementia Care: a care coordination intervention for individuals with dementia and their family caregivers | Qualitative descriptive analysis | Huston, Texas and Boston, Massachusetts, US | Home and community | Phone | Veterans with dementia and their primary caregivers | Interdisciplinary team included the VA Dementia Care Coordinator who worked in the Veterans Affairs, and the Alzheimer’s Association Care Consultant who worked in the Alzheimer’s Association chapter | Care coordinator |
| Lee et al.,61 2014 | Integrating community services into primary care: improving the quality of dementia care | Qualitative exploratory study | Ontario, Canada | Community (based out of primary care clinic) | In person | People with mild cognitive impairment or dementia and their caregivers | Interdisciplinary team included a physician, nurse practitioner, registered nurse, social worker, occupational therapist, and pharmacist | Clinic coordinator |
| Liu et al.,68 2019 | Patient and caregiver outcomes and experiences with team-based memory care: a mixed methods study | Mixed methods | Southeastern US | Community (based out of memory clinic) | Phone and in person | People with dementia and other memory issues and their caregivers | Interdisciplinary team made up of a geriatric physician, nurse, nurse practitioner, and social worker who functioned as the dementia navigator | Dementia navigator |
| McAiney et al.,60 2012 | ‘Throwing a lifeline’: the role of First Link™ in enhancing support for individuals with dementia and their caregivers | Mixed methods | Ontario and Saskatchewan, Canada | Home and community | Phone | People with dementia and their caregiver | Lay team made up of First Link Coordinator who worked with Alzheimer Society and the family | First Link coordinator |
| Merrilees et al.,40 2020 | The Care Ecosystem: promoting self-efficacy among dementia family caregivers | Qualitative exploratory study | California, Nebraska, and Iowa, US | Home and community | Phone, email, mail, and in person | Dyads made up of people with dementia and caregivers | Interdisciplinary team made up of care team navigators, advanced practice nurse, social worker, and pharmacist | Care team navigator |
| Morgan et al.,49 2015 | A break-even analysis for dementia care collaboration: Partners in Dementia Care | Cost analysis | US | Home and community | Phone and email | Veterans with dementia and their caregivers | Interdisciplinary team made up of Veterans Health Administration Coordinator and Alzheimer’s Association coordinator | Alzheimer’s Association care coordinator |
| Morgan et al.,50 2019 | Does care consultation affect use of VHA versus non-VHA care? | Cross-sectional research study | 5 regions in the US | Home and community | Phone | Veterans with dementia and their primary caregivers | Interdisciplinary team made up of half-time Veterans Health Administration dementia care coordinator and a half-time Alzheimer’s Association care consultant | Alzheimer’s Association care coordinator |
| Possin et al.,41 2017 | Development of an adaptive, personalized, and scalable dementia care program: early findings from the Care Ecosystem | Pragmatic randomized controlled trial | US | Home and community | Phone, email, and in person | People diagnosed with dementia of any type by any medical provider; 45 years and older; Medicare- or Medicaid-enrolled or pending; residing in California, Nebraska, or Iowa; a caregiver who may or may not reside with the patient; and fluency in English, Spanish, or Cantonese | Interdisciplinary team made up of care team navigators, dementia specialist nurse, social worker, and pharmacist | Care team navigator |
| Possin et al.,42 2019 | Effect of collaborative dementia care via telephone and internet on quality of life, caregiver well-being, and health care use: the Care Ecosystem randomized clinical trial | Randomized controlled trial | California, Nebraska, and Iowa, US | Home and community (based out of urban academic health centers) | Phone, email, and mail | Dyads made up of people with dementia and their caregiver; diagnosis required; speaking either English, Spanish, or Cantonese, residing in Iowa, California, or Nebraska | Interdisciplinary team consisting of a care team navigator, advanced practice nurse, social worker, and pharmacist | Care team navigators |
| Rosa et al.,43 2019 | Variations in costs of a collaborative care model for dementia | Cost analysis | California, Nebraska, and Iowa, US | Home and community (based out of urban academic health centers) | Phone, email, and in person | Dyads of persons with dementia and their caregiver; diagnosis required; speaking either English, Spanish, or Cantonese, residing in Iowa, California, or Nebraska | Interdisciplinary team consisting of a care team navigator, advanced practice clinical nurse, social worker, and pharmacist | Care team navigators |
| Samus et al.,33 2014 | A multidimensional home-based care coordination intervention for elders with memory disorders: the Maximizing Independence at Home (MIND) pilot randomized trial | Randomized controlled trial | Baltimore, Maryland, US | Home and community | Phone, email, and in person | People with cognitive disorder, 70 years and older, English-speaking, living in the community, had a reliable study partner (dyad) | Interdisciplinary team made up of community workers (coordinators), registered nurse, and geriatric psychiatrist | Memory care coordinator |
| Samus et al.,34 2015 | A multipronged, adaptive approach for the recruitment of diverse community-residing elders with memory impairment: The MIND at Home experience | Descriptive analysis | Baltimore, Maryland, US | Home and community | Phone and in person | Community-residing people in northwest Baltimore (28 postal codes), 70 years and older, English-speaking, met criteria for dementia or cognitive disorder, and had a reliable study partner (dyad) | Interdisciplinary team made up of trained nonclinical community workers (ie, memory care coordinator), nurses, physicians (ie, geriatric psychiatrists), and occupational therapists | Memory care coordinator |
| Samus et al.,35 2017 | Comprehensive home-based care coordination for vulnerable elders with dementia: Maximizing Independence at Home-Plus—study protocol | Protocol for randomized controlled trial | US | Home and community | Phone and in person | People with dementia and their caregivers | Interdisciplinary made up of geriatric psychiatrist, registered nurse, occupational therapist, memory care coordinator | Memory care coordinator |
| Samus et al.,36 2018 | MIND at Home-streamlined: study protocol for a randomized trial of home-based care coordination for persons with dementia and their caregivers | Protocol for randomized controlled trial | Baltimore, Maryland, US | Home and community | Phone and in person | Community-residing people in northwest Baltimore (28 postal codes), 70 years and older, English-speaking, met criteria for dementia or cognitive disorder, and had a reliable study partner (dyad) | Interdisciplinary team made up of geriatric psychiatrist, registered nurse, occupational therapist, memory care coordinator | Memory care coordinator |
| Silverstein et al.,58 2015 | The Alzheimer’s Association Dementia Care Coordination program: a process evaluation, executive summary | Mixed methods | Massachusetts and New Hampshire, US | Community | In person | People with dementia and their families | N/A | Care consultant |
| Tanner et al.,37 2015 | A randomized controlled trial of a community-based dementia care coordination intervention: effects of MIND at Home on caregiver outcome | Randomized controlled trial | Baltimore, Maryland, US | Home and community | Phone and in person | Community-residing people in northwest Baltimore (28 postal codes), 70 years and older, English-speaking, met criteria for dementia or cognitive disorder, and had a reliable study partner (dyad) | Interdisciplinary team made up of geriatric psychiatrist, registered nurse, occupational therapist, memory care coordinator | Memory care coordinator |
| Taylor et al.,62 2015 | The Primary Care Navigator programme for dementia: benefits of alternative working models | Report using qualitative assessment | Gateshead and Halton, UK | Community (based out of a general practitioner practice and a well-being enterprises community interest company) | Phone and in person | People with dementia, pre- and post-diagnosis | Clinical; each site organized differently. At Gateshead, 2 people shared the primary care navigator role, switching roles as health care assistant and primary care navigator weekly. They worked with a clinical team, which included doctors, a registrar, nurse practitioners, and a nursing team. At Halton, 10 community well-being officers acted as primary care navigators. They had clinical backgrounds. They partnered with 17 practices. | Primary care navigator |
| Tjia,44 2019 | A telephone-based dementia care management intervention-finding the time to listen | Editorial/ invited commentary | California, Nebraska, and Iowa, US | Home and community (based out of urban academic health centers) | Phone and email | Dyads made up of people with dementia and their caregivers; diagnosis required, speaking English, Spanish or Cantonese, and residing in Iowa, California, or Nebraska | Interdisciplinary team made up of a care team navigator, dementia specialist nurse, social worker, and pharmacist | Care team navigators |
| Willink et al.,38 2020 | Cost-effective care coordination for people with dementia at home | Prospective, quasi-experimental intervention trial design | Baltimore and Maryland suburban District of Columbia, US | Home and community | Phone and in person | Community-residing people in northwest Baltimore (28 postal codes), 70 years and older, English-speaking, met criteria for dementia or cognitive disorder, and had a reliable study partner (dyad) | Interdisciplinary team made up of geriatric psychiatrist, registered nurse, occupational therapist, memory care coordinator | Memory care coordinator |
| Wood et al.,52 2017 | A holistic service for everyone with a dementia diagnosis (innovative practice) | Report | Islington borough of London, UK | Home and community | Phone, mail, and in person | People with dementia and their caregivers | Interdisciplinary team made up of dementia navigators, 3 full-time assistant practitioners, and specialist practitioner as team leader | Dementia navigators |
| Xiao et al.,64 2016 | The effect of a personalized dementia care intervention for caregivers from Australian minority groups | Randomized controlled trial | Adelaide, South Australia | Home and community | Phone and in person | Dyads made up of people with dementia and their caregivers; caregivers were from a minority group, living at home | Interdisciplinary team made up of 8 care coordinators, which included a registered nurse, a social worker, and 6 Community Home Care Certificate holders | Care coordinator |
N/A, not applicable.