Home care for the elderly with dementia: a systematic review

With the global population aging, there is a growing need for home-based care to meet the health needs of the elderly. However, the quality of care provided to the aged population is now arguably a significant challenge for most healthcare systems worldwide.

Methods:

The present review included 13 original studies on home care and its effects on dementia patients, describing how patient care and adequate treatment can be collaborative for their improvement, for case management, and optimizing pain control and specificities.

Results:

Among the findings, it was evidenced that the environment impacts the form of care, once being at home can improve communication and global monitoring of dementia patients.

Conclusion:

In addition to the results analyzed in this review, there is a need for future, well-designed studies on the different aspects of home care, highlighting the importance of evaluating the type of care for each patient in the quest to optimize the care.

Keywords:
Home Care Services; Aged; Disability Evaluation; Dementia; Rehabilitation

Author	Design	Sample	Objective	Main results
Bonnefoy et al.,¹⁵15. Bonnefoy M, Boutitie F, Mercier C, Gueyffier F, Carre C, Guetemme G, et al. Efficacy of a home-based intervention programme on the physical activity level and functional ability of older people using domestic services: a randomised study. J Nutr Health Aging. 2012;16(4):370-7. https://doi.org/10.1007/s12603-011-0352-6 https://doi.org/10.1007/s12603-011-0352-...	Randomized trial	102 participants	To assess whether a home-based program supervised by home helpers during their normal working hours can prevent excessive sedentariness and preserve functional status in elderly people at risk of frailty or disability and using domestic services.	This study confirmed the feasibility of a supervised prevention program and some benefit from the intervention and identifies predictors for better compliance
Darton et al.,¹⁹19. Darton R, Bäumker T, Callaghan L, Holder J, Netten A, Towers AM. The characteristics of residents in extra care housing and care homes in England. Health Soc Care Community. 2012;20(1):87-96. https://doi.org/10.1111/j.1365-2524.2011.01022.x https://doi.org/10.1111/j.1365-2524.2011...	Cross-sectional	Residents of 19 extra care schemes with a comparative sample of people admitted to care homes.	This paper presents findings on the characteristics of the residents at the time of moving in, drawing on information collected from the 19 schemes in the evaluation, and a recent comparable study of residents who moved into care homes providing personal care.	Although extra-care housing may be operating as an alternative to care homes for some individuals, it is providing for a wider population, who may be making a planned move rather than reacting to a crisis.
Fleming et al.,²³23. Fleming MO, Haney TT. Improving patient outcomes with better care transitions: the role for home health. Cleve Clin J Med. 2013;80 Electronic Suppl 1:eS2-6. https://doi.org/10.3949/ccjm.80.e-s1.02 https://doi.org/10.3949/ccjm.80.e-s1.02...	Case report	1 patient	To understand the fragmentation of care, characterized by miscommunications and lack of follow-up, which can lead to oversights in diagnosis and management.	Reduced hospital readmissions and a critical role for the home health industry in improving patient outcomes and reducing costs.
Wu et al.,¹⁴14. Wu CY, Hu HY, Huang N, Fang YT, Chou YJ, Li CP. Determinants of long-term care services among the elderly: a population-based study in Taiwan. PLoS One. 2014;9(2):e89213. https://doi.org/10.1371/journal.pone.0089213 https://doi.org/10.1371/journal.pone.008...	Cross-sectional	2,608 participants	To investigate determinants of long-term care use and to clarify the differing characteristics of home/community-based and institution-based services users.	Age, single marital status, stroke, dementia, and ADL disability are predictive factors for long-term care use. The utilization was directly proportional to the level of disability.
Dorresteijn et al.,¹⁶16. Dorresteijn TAC, Zijlstra GAR, Ambergen AW, Delbaere K, Vlaeyen JWS, Kempen GIJM. Effectiveness of a home-based cognitive behavioral program to manage concerns about falls in community-dwelling, frail older people: results of a randomized controlled trial. BMC Geriatr. 2016;16:2. https://doi.org/10.1186/s12877-015-0177-y. Erratum in: BMC Geriatr. 2016;16:108. https://doi.org/10.1186/s12877-016-0278-2 https://doi.org/10.1186/s12877-015-0177-...	Randomized controlled trial	389 people	To assess the effectiveness of a home-based cognitive behavioral program on concerns over falls, in frail, older people living in the community.	At 12 months, the intervention group showed significantly lower levels of concerns over falls compared to the control group. Furthermore, significant reductions in activity avoidance, disability and indoor falls were identified in the intervention group compared with the control group.
Kamitani et al.,²¹21. Kamitani H, Umegaki H, Okamoto K, Kanda S, Asai A, Maeda K, et al. Development and validation of a new quality of life scale for patients receiving home-based medical care: the Observational Study of Nagoya Elderly with Home Medical Care. Geriatr Gerontol Int. 2017;17(3):440-8. https://doi.org/10.1111/ggi.12735 https://doi.org/10.1111/ggi.12735...	Observational study	40 patients	To develop and validate a scale that assesses quality of life in patients receiving home-based medical care.	The scale’s internal consistency was confirmed, as was its external validity.
Kasteridis et al.,¹³13. Kasteridis P, Mason A, Goddard M, Jacobs R, Santos R, Rodriguez-Sanchez B, et al. Risk of care home placement following acute hospital admission: effects of a pay-for-performance scheme for dementia. PLoS One. 2016;11(5):e0155850. https://doi.org/10.1371/journal.pone.0155850 https://doi.org/10.1371/journal.pone.015...	Cross-sectional	170,387 patients	To run multi-level logit models to assess the impact of the Quality and Outcomes Framework, or QOF review, on the risk of care home placement following emergency admission to hospital.	The QOF dementia review may help to reduce the risk of long-term care home placement following acute hospital admission.
Szanton et al.,¹⁷17. Szanton SL, Alfonso YN, Leff B, Guralnik J, Wolff JL, Stockwell I, et al. Medicaid cost savings of a preventive home visit program for disabled older adults. J Am Geriatr Soc. 2018;66(3):614-20. https://doi.org/10.1111/jgs.15143 https://doi.org/10.1111/jgs.15143...	Single-arm clinical trial	2,217 participants	To determine whether the Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program saves Medicaid more money than it costs to provide.	CAPABLE is associated with lower likelihood of inpatient and long-term service use and lower overall Medicaid spending. The magnitude of reduced Medicaid spending could pay for CAPABLE delivery and provide further Medicaid program savings due to averted services use.
Watanabe et al.,¹⁸18. Watanabe K, Umegaki H, Huang CH, Martins BA, Asai A, Kanda S, et al. Association between dysphagia risk and unplanned hospitalization in older patients receiving home medical care. Geriatr Gerontol Int. 2019;19(10):977-81. https://doi.org/10.1111/ggi.13753 https://doi.org/10.1111/ggi.13753...	Clinical trial	178 patients	To investigate the medical health of older adults receiving home medical care services.	Dysphagia risk predicts the first unexpected hospitalization in older individuals receiving home medical care.
Kim et al.,²⁵25. Kim J, Choi Y, Park EC. Incidence of hip fracture among long-term care insurance beneficiaries with dementia: comparison of home care and institutional care services. BMC Geriatr. 2019;19(1):152. https://doi.org/10.1186/s12877-019-1161-8 https://doi.org/10.1186/s12877-019-1161-...	Retrospective cohort study	7,112 people	To investigate the association between the type of long-term care service and the incidence of hip fracture among older adults with dementia receiving long-term care insurance, and to investigate how said association differs according to characteristics of beneficiaries and structural characteristic of institutional care.	Institutional care was more likely to be associated with a higher incidence of hip fracture than home care.
Husebo et al.,²²22. Husebo BS, Allore H, Achterberg W, Angeles RC, Ballard C, Bruvik FK, et al. LIVE@Home.Path-innovating the clinical pathway for home-dwelling people with dementia and their caregivers: study protocol for a mixed-method, stepped-wedge, randomized controlled trial. Trials. 2020;21(1):510. https://doi.org/10.1186/s13063-020-04414-y https://doi.org/10.1186/s13063-020-04414...	Clinical trial	315 participants	The article describes the rationale, development, feasibility testing, and implementation process of the LIVE@Home.Path trial.	As the article concludes, we hope that implementing LIVE will lead to a pathway to dementia treatment and care that is cost-effective, viable, and supports independent living at home. Does not demonstrate other results.
Barker et al.,²⁴24. Barker KL, Room J, Knight R, Dutton SJ, Toye F, Leal J, et al. Outpatient physiotherapy versus home-based rehabilitation for patients at risk of poor outcomes after knee arthroplasty: CORKA RCT. Health Technol Assess. 2020;24(65):1-116. https://doi.org/10.3310/hta24650 https://doi.org/10.3310/hta24650...	Clinical trial	621 patients	To compare the outcomes from a traditional outpatient physiotherapy model with those from a home-based rehabilitation program for people assessed as being at risk of a poor outcome after knee arthroplasty.	Found no important differences in outcomes when post-arthroplasty rehabilitation was delivered using home-based rehabilitation. However, the health economic analysis found that when adopting a societal perspective, home-based rehabilitation had a 75% probability of being cost-effective at a threshold of £30,000 per quality-adjusted life-year
Vislapuu et al.,²⁰20. Vislapuu M, Angeles RC, Berge LI, Kjerstad E, Gedde MH, Husebo BS. The consequences of COVID-19 lockdown for formal and informal resource utilization among home-dwelling people with dementia: results from the prospective PAN.DEM study. BMC Health Serv Res. 2021;21(1):1003. https://doi.org/10.1186/s12913-021-07041-8 https://doi.org/10.1186/s12913-021-07041...	Clinical trial	105 patients	To investigate the consequences of restrictions on formal (homecare staff) and informal (family, friends) resource utilization among co-residing (e.g., spouses) and visiting caregivers (e.g., children).	The care situation changed dramatically in the early phase of the COVID-19 pandemic, especially for those living alone who received less support from homecare services and visiting caregivers.

Quality criteria	Autor	Selection (****)	Comparability (*)	Outcome(*)
Selection/design	Autor	Selection (****)	Comparability (*)	Outcome(*)
Randomized trial	Bonnefoy et al.,¹⁵15. Bonnefoy M, Boutitie F, Mercier C, Gueyffier F, Carre C, Guetemme G, et al. Efficacy of a home-based intervention programme on the physical activity level and functional ability of older people using domestic services: a randomised study. J Nutr Health Aging. 2012;16(4):370-7. https://doi.org/10.1007/s12603-011-0352-6 https://doi.org/10.1007/s12603-011-0352-...	***	*	*
Retrospective cohort study	Kim et al.,²⁵25. Kim J, Choi Y, Park EC. Incidence of hip fracture among long-term care insurance beneficiaries with dementia: comparison of home care and institutional care services. BMC Geriatr. 2019;19(1):152. https://doi.org/10.1186/s12877-019-1161-8 https://doi.org/10.1186/s12877-019-1161-...	****	*	*
Cross-sectional	Darton et al.,¹⁹19. Darton R, Bäumker T, Callaghan L, Holder J, Netten A, Towers AM. The characteristics of residents in extra care housing and care homes in England. Health Soc Care Community. 2012;20(1):87-96. https://doi.org/10.1111/j.1365-2524.2011.01022.x https://doi.org/10.1111/j.1365-2524.2011...	**	*	*
Cross-sectional	Wu et al.,¹⁴14. Wu CY, Hu HY, Huang N, Fang YT, Chou YJ, Li CP. Determinants of long-term care services among the elderly: a population-based study in Taiwan. PLoS One. 2014;9(2):e89213. https://doi.org/10.1371/journal.pone.0089213 https://doi.org/10.1371/journal.pone.008...	****	*	*
Cross-sectional	Kasteridis et al.,¹³13. Kasteridis P, Mason A, Goddard M, Jacobs R, Santos R, Rodriguez-Sanchez B, et al. Risk of care home placement following acute hospital admission: effects of a pay-for-performance scheme for dementia. PLoS One. 2016;11(5):e0155850. https://doi.org/10.1371/journal.pone.0155850 https://doi.org/10.1371/journal.pone.015...	***	*	*
Case report	Fleming et al.,²³23. Fleming MO, Haney TT. Improving patient outcomes with better care transitions: the role for home health. Cleve Clin J Med. 2013;80 Electronic Suppl 1:eS2-6. https://doi.org/10.3949/ccjm.80.e-s1.02 https://doi.org/10.3949/ccjm.80.e-s1.02...	**	*	*
Randomized controlled trial	Dorresteijn et al.,¹⁶16. Dorresteijn TAC, Zijlstra GAR, Ambergen AW, Delbaere K, Vlaeyen JWS, Kempen GIJM. Effectiveness of a home-based cognitive behavioral program to manage concerns about falls in community-dwelling, frail older people: results of a randomized controlled trial. BMC Geriatr. 2016;16:2. https://doi.org/10.1186/s12877-015-0177-y. Erratum in: BMC Geriatr. 2016;16:108. https://doi.org/10.1186/s12877-016-0278-2 https://doi.org/10.1186/s12877-015-0177-...	**	*	*
Observational study	Kamitani et al.,²¹21. Kamitani H, Umegaki H, Okamoto K, Kanda S, Asai A, Maeda K, et al. Development and validation of a new quality of life scale for patients receiving home-based medical care: the Observational Study of Nagoya Elderly with Home Medical Care. Geriatr Gerontol Int. 2017;17(3):440-8. https://doi.org/10.1111/ggi.12735 https://doi.org/10.1111/ggi.12735...	***	*	*
Single-arm clinical trial	Szanton et al.,¹⁷17. Szanton SL, Alfonso YN, Leff B, Guralnik J, Wolff JL, Stockwell I, et al. Medicaid cost savings of a preventive home visit program for disabled older adults. J Am Geriatr Soc. 2018;66(3):614-20. https://doi.org/10.1111/jgs.15143 https://doi.org/10.1111/jgs.15143...	****	*	*
Clinical trial	Watanabe et al.,¹⁸18. Watanabe K, Umegaki H, Huang CH, Martins BA, Asai A, Kanda S, et al. Association between dysphagia risk and unplanned hospitalization in older patients receiving home medical care. Geriatr Gerontol Int. 2019;19(10):977-81. https://doi.org/10.1111/ggi.13753 https://doi.org/10.1111/ggi.13753...	**	*	*
Clinical trial	Husebo et al.,²²22. Husebo BS, Allore H, Achterberg W, Angeles RC, Ballard C, Bruvik FK, et al. LIVE@Home.Path-innovating the clinical pathway for home-dwelling people with dementia and their caregivers: study protocol for a mixed-method, stepped-wedge, randomized controlled trial. Trials. 2020;21(1):510. https://doi.org/10.1186/s13063-020-04414-y https://doi.org/10.1186/s13063-020-04414...	**	*	*
Clinical trial	Barker et al.,²⁴24. Barker KL, Room J, Knight R, Dutton SJ, Toye F, Leal J, et al. Outpatient physiotherapy versus home-based rehabilitation for patients at risk of poor outcomes after knee arthroplasty: CORKA RCT. Health Technol Assess. 2020;24(65):1-116. https://doi.org/10.3310/hta24650 https://doi.org/10.3310/hta24650...	***	*	*
Clinical trial	Vislapuu et al.,²⁰20. Vislapuu M, Angeles RC, Berge LI, Kjerstad E, Gedde MH, Husebo BS. The consequences of COVID-19 lockdown for formal and informal resource utilization among home-dwelling people with dementia: results from the prospective PAN.DEM study. BMC Health Serv Res. 2021;21(1):1003. https://doi.org/10.1186/s12913-021-07041-8 https://doi.org/10.1186/s12913-021-07041...	**	*	*

Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Correspondence: Luísa Pelucio; Email: luisapelucio@hotmail.com.