Supporting elderly people with cognitive impairment during and after hospital stays with Intersectoral Care Management – results of a randomized controlled trial

Abstract

AbstractBackgroundThere is a need to examine whether evidence based collaborative care management can be beneficial to people with cognitive impairment transitioning from hospital to primary care.MethodWe conducted a longitudinal multisite randomized controlled trial with two arms (care as usual and care as usual + intersectoral care management) and two follow‐ups 3 and 12 months after hospital discharge. The sample under analysis consists of n = 401 participants from 3 different hospitals in Germany who were at least 70 years old, cognitively impaired and community‐dwelling.A comprehensive assessment of medical, nursing and psychosocial data at time of admission was analyzed using pre‐specified algorithms to develop an individualized treatment and care plan. After discharge, care managers visited participants at home, aligned the plan and supported participants for up to 3 months afterwards.Primary outcomes were the rate of re‐admission to hospital, and physical and instrumental functionality (activities of daily living, ADL) after 3 months and rate of institutionalization and ADL after 12 months. Secondary outcomes of interest were: health related quality of life, depressive symptoms, cognitive status and frailty. Statistical analyses include regression models controlled for various factors.ResultThere was no statistically significant effect on the re‐admission rate after 3 months, the activities of daily living, or the institutionalization rate. However, analyses show a significant effect of collaborative care management on health related quality of life 3 as well as 12 months after hospital discharge. Furthermore, depressive symptoms were significantly less likely in the intervention group 3 months after discharge. No effects on cognition or frailty were shown.ConclusionDementia care management has a positive effect on cognitively impaired older people during and after their hospital stay. There is an effect on quality of life and mental wellbeing. It is arguable why there is none on ADL. There is a need to discuss whether it is an appropriate primary outcome measure for a complex care intervention, as the intervention is targeting the needs associated with impaired functionality rather than functionality directly. Further limitations are discussed in more detail.