The effectiveness of community-based coordinating interventions in dementia care: a meta-analysis and subgroup analysis of intervention components
Open accessAbstract
Interventions aiming to coordinate services for the community-based dementia population vary in components, organisation and implementation. In this review we aimed to evaluate the effectiveness of community-based care coordinating interventions on health outcomes and investigate whether specific components of interventions influence their effects. We searched four databases from inception to April 2017: Medline, The Cochrane Library, EMBASE and PsycINFO. This was aided by a search of four grey literature databases, and backward and forward citation tracking of included papers. Title and abstract screening was followed by a full text screen by two independent reviewers, and quality was assessed using the CASP appraisal tool. We then conducted meta-analyses and subgroup analyses. A total of 14 randomised controlled trials (RCTs) involving 10,372 participants were included in the review. Altogether we carried out 12 meta-analyses and 19 subgroup analyses. Meta-analyses found coordinating interventions showed a statistically significant improvement in both patient behaviour measured using the Neuropsychiatric Inventory (NPI) (mean difference (MD) = −9.5; 95% confidence interval (CI): −18.1 to −1.0; p = 0.03; number of studies (n) = 4; I 2 = 88%) and caregiver burden (standardised mean difference (SMD) = −0.54; 95% CI: -1.01 to −0.07; p = 0.02; n = 5, I 2 = 92%) compared to the control group. Subgroup analyses found interventions using a case manager with a nursing background showed a greater positive effect on caregiver quality of life than those that used case managers from other professional backgrounds (SMD = 0.94 versus 0.03, respectively; p < 0.001). Interventions that did not provide supervision for the case managers showed greater effectiveness for reducing the percentage of patients that are institutionalised compared to those that provided supervision (odds ratio (OR) = 0.27 versus 0.96 respectively; p = 0.02). There was little evidence of effects on other outcomes, or that other intervention components modify the intervention effects. Results show that coordinating interventions in dementia care has a positive impact on some outcomes, namely patient behaviour and caregiver burden, but the evidence is inconsistent and results were not strong enough to draw definitive conclusions on general effectiveness. With the rising prevalence of dementia, effective complex interventions will be necessary to provide high quality and effective care for patients, and facilitate collaboration of health, social and third sector services.
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Multicomponent dementia care models with person-centred care coordination aim to target assessment of risk and need for the person living with dementia and family carer using evidence-based approaches, which may include neuropsychiatric symptoms and carer quality of life.
“Multicomponent dementia care models with person-centred care coordination aim to target assessment of risk and need for the person living with dementia and family carer using evidence-based approaches, which may include neuropsychiatric symptoms and carer quality of life. (478)”
From Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission (2024) · cites this paper as [478]
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Experimental — accuracy not yet measuredIndividual studies of care coordination have shown reduced care home admission and cost-effectiveness from a societal and individual perspective, but a meta-analysis of 14 care coordination RCTs did not show a statistically significant reduction in care home admission or hospitalisation.
“Individual studies of care coordination have shown reduced care home admission, and cost-effectiveness from a societal and individual perspective,(479) but a meta-analysis of 14 care coordination RCTs did not show a statistically significant reduction in care home admission or hospitalisation. (478)”
From Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission (2024) · cites this paper as [478]
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Fæø, S. E., Tranvåg, O., Samdal, R., Husebo, B. S., & Bruvik, F. K. (2020) · Figshare · doi:10.6084/m9.figshare.13245340
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Acoustic Analysis of Primary Care Patient-provider Conversations to Screen for Cognitive ImpairmentPreprint
Colonel, J. T., Becker, J., Chan, L., Faherty, C., Vleck, T. T. V., Curtis, L. M., Wisnivesky, J. P., Federman, A. D., & Lin, B. (2025) · medRxiv · doi:10.64898/2025.12.27.25343088
Collective efficacy and community readiness for dementia prevention: a spatial spillover analysis
Chen, D., Kuo, C.-T., & Wu, T.-C. (2026) · Geospatial health · doi:10.4081/gh.2026.1476
Acoustic Analysis of Primary Care Patient–Clinician Conversations to Screen for Cognitive Impairment
Colonel, J. T., Becker, J., Chan, L., Faherty, C., Hackett, K., Carnavali, F., Vleck, T. T. V., Curtis, L., Wisnivesky, J., Federman, A., et al. (2026) · JAMA Neurology · doi:10.1001/jamaneurol.2026.1868 · Cited by 1 · see citing works
Chen, Y.-C., Li, Y.-C., Hong, R.-B., Shih, Y.-C., & Chang, J. (2026) · Healthcare · doi:10.3390/healthcare14203512
- Authors
- Backhouse, A., Ukoumunne, O. C., Richards, D. A., McCabe, R., Watkins, R., & Dickens, C.
- Affiliations
- University of Exeter (GB)
- Corresponding author
- Backhouse, Amy
- Venue
- BMC Health Services Research
- Published
- 2017-11-13
- Volume
- 17
- Issue
- 1
- Pages
- 717-717
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC5683245
- OpenAlex
- W2769045223
- Cited by
- 65
- References
- 30
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 8 · 2023: 13 · 2022: 11 · 2021: 5 · 2020: 13 · 2019: 2 · 2018: 2 · 2017: 1
- FWCI
- 0.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- City Research Online (City University London) (acceptedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Explore Bristol Research (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion)
- Open Research Exeter (University of Exeter) (submittedVersion, cc-by)
- Bristol Research (University of Bristol) (submittedVersion, cc-by)
- Funders
- National Institute for Health Research
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- dementia care, care coordination, community-based care, case management, caregiver burden, caregiver quality of life, neuropsychiatric symptoms, institutionalization, intervention components, complex interventions, health outcomes
- MeSH terms
- Community Mental Health Services, Dementia, Humans, Long-Term Care, Quality of Life, Randomized Controlled Trials as Topic, Treatment Outcome, Caregivers
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