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 detection EBP 2: Effective Hospital Care |
Organization:
|
IQ Healthcare Health Evidence |
Former Organization:
|
Centre for Quality of Care Research
|
Journal title:
|
Journal of the American Geriatrics Society
|
Abstract:
|
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.
|