Effectiveness of nonpharmacological interventions in delaying the institutionalization of patients with dementia: a meta-analysis.

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Publication year
2008Source
Journal of the American Geriatrics Society, 56, 6, (2008), pp. 1116-28ISSN
Publication type
Article / Letter to editor

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Organization
IQ Healthcare
Health Evidence
Former Organization
Centre for Quality of Care Research
Journal title
Journal of the American Geriatrics Society
Volume
vol. 56
Issue
iss. 6
Page start
p. 1116
Page end
p. 28
Subject
EBP 2: Effective Hospital Care; EBP 3: Effective Primary Care and Public Health; EBP 4: Quality of Care; NCEBP 11: Alzheimer Centre; NCEBP 2: Evaluation of complex medical interventions; NCEBP 4: Quality of hospital and integrated care; NCEBP 7: Effective primary care and public health; ONCOL 1: Hereditary cancer and cancer-related syndromes; ONCOL 4: Quality of Care; ONCOL 5: Aetiology, screening and detectionAbstract
Contemporary healthcare policies are designed to shape the conditions that can help delay the institutionalization of patients with dementia. This can be done by developing support programs that minimize healthcare risks for the patients with dementia and their informal caregivers. Many support programs have been developed, and some of them are effective, but there has been no systematic review with a meta-analysis of all types of nonpharmacological support programs with odds of institutionalization or time to institutionalization as an outcome measure. A systematic review with a meta-analysis was therefore conducted to estimate the overall effectiveness of nonpharmacological support programs for caregivers and patients with dementia that are intended to delay institutionalization. Thirteen support programs with a total of 9,043 patients were included in the meta-analyses. The estimated overall effectiveness suggests that these programs significantly decrease the odds of institutionalization (odds ratio (OR)=0.66, 95% confidence interval (CI)=0.43-0.99, P=.05) and significantly increase the time to institutionalization (standardized mean difference (SMD)=1.44, 95% CI=0.07-2.81, P=.04). A meta-analysis of the best-quality studies still showed a positive significant result for the odds of institutionalization (OR=0.60, 95% CI=0.43-0.85, P=.004), although the time to institutionalization was no longer significant (SMD=1.55, 95% CI=-0.35- 3.45, P=.11). The analysis of the intervention characteristics showed that actively involving caregivers in making choices about treatments distinguishes effective from ineffective support programs. Further investigation should be directed toward calculating the potential efficiency of these support programs by applying net-benefit or cost-effectiveness analysis.
This item appears in the following Collection(s)
- Academic publications [232014]
- Electronic publications [115251]
- Faculty of Medical Sciences [89012]
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