Table 3.

Randomised Controlled Trials – Case Manager Roles – Level II evidence

Article	Sample	Intervention	Control	Outcome measures	Outcomes/results
Chien and Lee 2008 [23] Hong Kong	N = 88 dyads Primary Caregivers and people with dementia.	• N = 44 Six-month Dementia education and support program for carers • Multi-disciplinary committee including psychiatrist, social worker, case nurse manager from each centre and researchers selected 25 intervention goals and objectives from the recommended dementia guidelines • Case management by a Nurse who received 32 h of formal training by researchers • Case manager: provided case management, coordinated all levels of family care according to the results of structured needs assessment, formulated a multidisciplinary education program for each family on effective dementia care, provided community support resources, and reviewed the program.	• N = 44 Routine Dementia care: pharmacotherapy and social and recreational activities, written educational material and six monthly-education sessions	• Caregiver burden – Family Care giving Burden Inventory • Quality of life – WHO Quality of Life Scale • Social support – Six-item Social Support Questionnaire • Symptom Severity – Neuropsychiatric Inventory and MMSE • Access of Community Services – Family Support Services Index	• No loss to follow-up • Significant reductions in the institutionalisation rate at 6 and 12 months • Significantly greater improvements in quality of life and burden in caregivers at 6 and 12 months • Significantly greater improvements in patients symptom severity at 6-months only • Significant reduction in family service utilisation at 12-months	Preliminary level II high quality evidence to support a 6 month dementia education and support management program for improving caregiver quality of life and burden and reducing institutionalisation rates
Chien and Lee 2011 [24] Hong Kong	N = 92 family members caring for a relative with dementia at home	• N = 46 • Six-month Dementia Family Care Programme – individualised education and support program for effective dementia care • Multi-disciplinary committee including psychiatrist, social worker, case nurse manager from each centre and researchers selected 25 intervention goals and objectives from the recommended dementia guidelines. • Case management by a Nurse who received 32 h of formal training by researchers • Case manager conducted weekly home visits, family health and educational needs assessment, education about dementia care and collaborated with caregivers to prioritise the problems and formulated an individualised education and support program for each family • Case manager guided each family using six step model: defining the problem, generation of alternatives, examining and evaluating each alternative, cognitive rehearsal of action plan, execution of plan as home work and evaluation of outcomes	• N = 46 • Routine family services including medical consultation, advice and referrals for financial aid and social welfare, education talks and social and recreational activities	• Caregiver burden – Family Caregiving Burden Inventory • Quality of life – WHO Quality of Life Scale • Social support – Six-item Social Support Questionnaire • Symptom Severity – Neuropsychiatric Inventory and MMSE • Access of Community Services – Family Support Services Index	• All 92 participant data included in follow-up • Statistically significant improvement in caregivers burden and quality of life over 18 months • Statistically significant improvement in dementia clients symptom severity over 18-months • Statistically significant improvement in frequency and length of institutionalisation over 18-months • Statistically significant reduction in utilisation of family services at 18 months	Preliminary level II high quality evidence to support a 6 month dementia family care programme with a needs based intervention with multi-disciplinary input for improving caregiver burden and quality of life and dementia clients symptom severity
Jansen et al., (2011) [25] The Netherlands	N = 99 pairs of community-dwelling older adults with dementia symptoms and their primary informal caregivers	• N = 54 • Four-months of case management by District Nurses specialised in geriatric care • Case managers coordinated assessments, gave advice and information, monitored care and assisted with planning, organisation and collaboration.	• N = 45 • Usual care which included a diversity of health care and welfare services that was accessed depending on people’s own initiative	• Caregivers sense of competence – Sense of Competence Questionnaire • Caregivers quality of life – MOS 36-item Short-Form Health Survey (SF-36) • Caregivers depressive symptoms – Center for Epidemiologic Studies Depression Scale (CES-D) • Burden – Self-Perceived Pressure by Informal Care • Patient quality of life – Dementia Quality of Life Instrument	• 80 % follow-up data for intervention group, 84 % control group • No differences over time between groups for sense of competency, quality of life, depressive symptoms, burden and patient quality of life	Lack of level II high quality evidence to support 4 months of case management for older adults with dementia symptoms and their primary caregivers to impact on sense of competency, quality of life, depressive symptoms, burden and patient quality of life
Lam et al., 2010 [26] Hong Kong	N = 102 Chinese community dwelling people with mild dementia (psychiatric and geriatric patients)	• N = 59 • Four-months of Case Management by a trained Occupational Therapist • Regular home visits, assessment and advice, evaluation of the activities of daily living, neuropsychiatric symptoms, caregiver distress and care duties. • Case manager advised caregivers and people with dementia about safe performance in basic self care activities to promote safe home living, behaviour management and communication techniques. Home based program was based on cognitive stimulation • The case manager also worked with the family/person at follow-up hospital clinic visits and liaised with psycho-geriatrician or geriatrician	• N = 43 • One home visit for home safely by occupational therapist no case management	Caregivers • Zarit Burden Scale • General Health Questionnaire • Personal Well-Being Index for Adult Persons with Dementia • Neuropsychiatric Inventory and MMSE • Cornell Scale for Depression in Dementia • Person-Wellbeing Index for Intellectually Disabled	• 90 % follow-up data for both groups • None of the changes of primary and secondary outcomes at 4 or 12 months showed significant group differences • At follow-up the case management group used more day care and domestic helpers than the control group	Lack of level II high quality evidence to support a 4 month active case management intervention to reduce caregiver burden in Chinese people with mild dementia in Hong Kong. However there was an increase in external supports in the intervention group.