Table 2.
Summary of Results on Interventions to Delay or Prevent Long-Term Nursing Home Placement (NHP) from Prioritized Systematic Reviews
| Interventions (# of prioritized reviews) |
Effect on NHP | Description of results |
|---|---|---|
| 13 systematic reviews that limited inclusion to RCTs† | ||
| Caregiver support (2) | ↔/↓ | 1 high-quality review21,67 reported qualitative summaries, stating caregiver interventions “did not consistently improve…institutionalization for patients with memory-related disorders,” but also highlighted results from 2 studies that demonstrated delay in NHP |
| ? | 1 high-quality review on cognitive reframing for caregivers found no RCTs reporting NHP27 | |
| Respite care and day programs (2) | ↔ | 1 high-quality review reported quantitative meta-analysis for adult day programs and found no overall decrease in NHP (OR 0.84, 95% CI 0.58, 1.21) or when separated by type of comparator30 |
| ? | 1 high-quality review on all types of respite care identified only 1 RCT, which reported delay in combined outcome of NHP or death35 | |
| Case management (2) | ↔ | 2 high-quality reviews reported quantitative meta-analyses for adults with dementia—1 review found inconsistent results across different follow-up intervals (reduction in NHP at 6 and 18 months, but not at 10–12 and 24 months);43 1 review found no overall decrease in NHP (RR 0.94 [95% CI 0.85, 1.03]) or delay in timing (WMD 77.8 days [95% CI − 70.5, 226.1])44 |
| Preventive home visits (1) | ↔/↓ | 1 medium-quality review reported quantitative meta-analysis and found no effect overall (RR 0.91 [95% CI 0.76, 1.09]) but suggested more intensive interventions (> 9 visits) may decrease NHP51 |
| Other (5) | ? | 2 medium-quality reviews on physical activity interventions for frail or pre-frail older adults found no RCT reporting NHP63,64 |
| ↔ | 1 high-quality review on a variety of interventions for falls prevention reported qualitative summaries that multifactorial programs and exercise-focused interventions showed inconsistent effects53 | |
| ? | 1 high-quality review on light therapy for adults with dementia found no RCT reporting NHP55 | |
| ? | 1 high-quality review on assistive technologies for adults with dementia found no RCT reporting NHP60 | |
| 7 systematic reviews that included observational studies | ||
| Respite care and day programs (1) | ↑/↓ | 1 high-quality review reported quantitative meta-analysis of “quasi-experimental”‡ studies finding increased NHP (OR 1.79 [95% CI 1.02, 3.12]), but also provided qualitative summary of observational cohort studies, stating that there was “some support for the benefits of respite care…”37 |
| Case management (2) | ↔/↓ | 1 high-quality review reported qualitative summary for adults with dementia, stating that programs ≤ 2 years did not “confer clinically important delays in time to [NHP]” (moderate strength of evidence), but interventions for those with “in-home spouse caregivers and continued services for longer than 2 years” may be effective (low strength of evidence)46 |
| ↔ | 1 high-quality review reported qualitative summary for adults with frailty or multimorbidity, stating no effect on NHP (low strength of evidence)46 | |
| ? | 1 high-quality review on “reablement” interventions for older adults found only 1 study reporting NHP41 | |
| Preventive home visits (1) | ↔ | 1 high-quality review reported quantitative meta-analysis and found no effect overall (RR 1.02 [95% CI 0.88, 1.18]) or by different follow-up intervals49 |
| Other (4) | ? | 1 high-quality review on home-based primary care found no study reporting NHP66 |
| ? | 1 medium-quality review on occupational therapy found only 1 study reporting NHP54 | |
| ? | 1 high-quality review on different settings or models of personal assistance found no studies reporting NHP57 | |
| ↓ | 1 low-quality review reported qualitative summary of demonstration projects to better integrate acute and long-term care, stating decreased NHP occurred in 2 projects62 | |
↑ increased or accelerated NHP, ↔ no meaningful difference or effect, ↓ delayed or prevented NHP, ? reviews identified none or only 1 study, CI confidence interval, HR hazards ratio, OR odds ratio, RR relative risk ratio, RCT randomized controlled trial, WMD weighted mean difference
*Reviews selected based on highest quality and most recent search
†These reviews explicitly allowed only RCTs as included study designs
‡Review authors defined these as observational studies with a comparison group