The content, dissemination and effects of case management interventions for informal caregivers of older adults: a systematic review.

Objectives: To investigate and describe the content, dissemination and effects of case management interventions for informal caregivers of older adults, focusing on outcomes related to patients' activities of daily living, nutrition assessment, pain measurement, depression, length of stay and to caregivers' satisfaction and difficulties.

Design: This systematic review was based on the Preferred Reporting Items for Systematic. Reviews and Meta-Analysis of studies that evaluate healthcare interventions (PRISMA) statement.

Data Sources: PubMed, CINAHL, and EMBASE were searched in September 2013 using a two-step search strategy combining an electronic search with a search in the reference lists. The search strategy was structured using the study inclusion criteria built on PICOS.

Review Methods: Studies were reviewed by title, abstract and full-text by both authors. Duplicates and studies not meeting the inclusion criteria were excluded. Data was extracted from the eligible studies using narrative synthesis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was employed to rate the quality of the evidence.

Results: Seven studies (5 RCTs) including a total of 6956 patients over the age of 65 and their informal caregivers (spouses, family members, and close relatives) all in community-care settings were found eligible and included in the review. The assessment for risk of bias in the seven studies indicated variations in the study quality from very low (n=4), to low (n=1) and moderate (n=2) due to lack of randomisation, blinding, transparency and not following intention to treat. A case management approach was claimed in four studies and the remaining three studies used a psycho-educational intervention with core components of case management consistent with the literature. Significant effects of case management interventions were seen on patients' time to institutionalisation, municipal care costs and emotional health when informal caregivers were involved. A significant effect was also found on informal caregivers' decrease in depressive symptoms over time.

Conclusion: Research of case management interventions for informal caregivers is very limited. This review identifies knowledge about case management as an intervention for informal caregivers to older patients, suggesting strengths and weaknesses for future interventions when informal caregivers are involved. PROSPERO registration: CRD42014007462.