The value of supportive care: A systematic review of cost-effectiveness of non-pharmacological interventions for dementia

Cost-Effectiveness of the Tailored Activity Programme for Person With Dementia-Caregiver Dyads: A Markov Model

OBJECTIVES

The Tailored Activity Programme (TAP) is a home-based programme with compelling outcomes for reducing behavioural and psychological symptoms of dementia and functional decline. We conducted a cost-utility analysis of TAP compared to usual care, for the person with dementia and their caregiver.

METHODS

We developed a Markov Model, from the healthcare sector perspective. Using parameters from the dementia care literature. Base-case and probabilistic sensitivity analyses were applied to handle uncertainty.

RESULTS

Given the growing need for cost-effective dementia care, understanding the cost-effectiveness of TAP is crucial for health service design and its implementation into healthcare settings. Our study shows that TAP is cost-effective for both males and females with dementia and their caregivers. The most favourable cost-effectiveness acceptability curves were found in men and women with dementia, aged 50 to 70, with lower costs and higher QALYs compared to those over 80. The probability of TAP being cost-effective rises with public higher willingness-to-pay thresholds, especially for people with dementia in the age group of 50-70.

CONCLUSIONS

These findings indicate TAP is highly cost-effective for individuals living with dementia compared to usual home care, which provides evidence for policy makers towards their decisions on resource allocation and for implementing TAP in Australia.

Focusing on Caregiver Neglect: A Novel Strategy for Mistreatment of Older Adults Screening and Intervention

Mistreatment of older adults is common and has serious health consequences but is underrecognized and underreported. Screening for mistreatment of older adults and initiation of intervention in primary care clinics may be helpful, but the value of existing tools is not supported by evidence. We argue that shifting the focus to individual subtypes of mistreatment of older adults can provide improved approaches to screening and ultimately to intervention. We focus on the example of caregiver neglect, the subtype associated with highest mortality. To develop caregiver neglect screening and intervention programs and to measure their effectiveness and impact, we assert that it is critical to: (1) define the phenomenon, (2) develop a conceptual model to explain why it occurs, (3) develop measurement strategies, and (4) systematically examine existing literature. We describe here the initial components of this development process.

Economic evaluations of technology-based interventions used to provide care support for people with mild dementia or mild cognitive impairment and their caregivers: A systematic review

BACKGROUND

The cost-effectiveness of interventions is a key issue owing to the limited resources of healthcare services.

OBJECTIVE

To conduct a systematic review of economic evaluations of technology-based healthcare interventions in care support for people with dementia or mild cognitive impairment (MCI) and their caregivers, and of the tools used to assess effectiveness and costs.

METHODS

The following databases were used: PubMed, National Health Service Economic Evaluation Database, and Health Technology Assessment. A total of 207 articles from 2012 to 2024 were identified and then screened.

RESULTS

Seventeen studies were included, of which nine were study protocols. Almost half (n = 8) the interventions were multicomponent. The most common components used in the interventions were cognitive stimulation, physical functioning and continuing support. Regarding the efficiency results of these interventions, only three studies provided a full economic evaluation. The most frequent tools in the economic evaluations used to measure effectiveness (measured in quality-adjusted life years) and costs were the European Quality of Life-5 Dimensions and Resource Utilization in Dementia instruments, respectively.

CONCLUSIONS

Most of the interventions evaluated were cost-effective. However, these results should be interpreted with caution, given the scarcity of the literature, and further economic evaluations of technology-based healthcare interventions for people with mild dementia or MCI care support and their caregivers are therefore needed. Additionally, a meta-analysis could not be performed due to the heterogeneity of the data.

Effects of COVID-19 nursing home restrictions on people with dementia involved in a Supportive Care programme

Background

Supportive Care is a person-centred approach encompassing non-pharmacological interventions targeted towards persons with dementia to contain the effects of their behavioural disorders, improving their quality of life.

Aims

To investigate the effects of lockdown restrictions during the first wave of COVID-19 pandemic on behavioural symptoms of patients involved in a Supportive Care programme in an Italian nursing home.

Methods

Analysis is based on Neuropsychiatric Inventory (NPI) scores and related symptoms data collected before (October/November 2019) and after (July 2020) the introduction of COVID-19 restrictions on a non-random sample of 75 patients living in two units of the facility: 38 involved in a Supportive Care programme and 37 receiving standard care (Control). Group performances were compared over time according to univariate statistics and Latent Class Analysis (LCA).

Results

NPI scores and number of reported symptoms in NPI evaluations increased over time among Supportive Care patients with dementia and decreased in the Control group. Differences are statistically significant. LCA resulted in 3-classes and 5-classes specifications in the two time-occasions.

Discussion

Supportive Care patients showed a worsening in behavioural and psychological symptoms after the first pandemic wave, as opposed to the elderly not involved in the programme. LCA showed that patients in the two groups differed according to the combinations of NPI symptoms.

Conclusions

The discontinuation of a Supportive Care programme due to COVID-19 restrictions had strong negative effects on nursing home persons with dementia involved in the programme: Supportive Care interventions are important in controlling the psycho-behavioural symptoms associated with dementia.

Dementia care and prevention in community settings: a built environment framework for cognitive health promotion

PURPOSE OF REVIEW

Most people with dementia live in the community. As lifespan increases, one in three persons aged 85+ are expected to live with dementia. We conduct a systematic search to identify frameworks for dementia care and prevention in community settings. This is important to ensure quality of life for people living with cognitive decline (PLCD).

RECENT FINDINGS

61 frameworks are synthesized into the dementia care and prevention in community (DCPC) framework. It highlights three levels of provision: built environment and policy supports, access and innovation, and inclusion across stages of decline. Domains of intervention include: basic needs; built environment health and accessibility; service access and use; community health infrastructure; community engagement; mental health and wellbeing; technology; end-of-life care; cultural considerations; policy, education, and resources. Personhood is not adequately represented in current built environment frameworks. This is supplemented with 14 articles on lived experiences at home and social practices that contribute to PLCD's social identity and psychological safety.

SUMMARY

Policy makers, health and built environment professionals must work together to promote "personhood in community" with PLCD. Clinicians and community staff may focus on inclusion, social identity and a sense of at-homeness as attainable outcomes despite diagnosis.