The use of case management for community-dwelling older people: the effects on loneliness, symptoms of depression and life satisfaction in a randomised controlled trial

Abstract

Aim: To investigate the effects of a case management intervention for community-dwelling frail older people, with functional dependency and repeated contacts with the healthcare services, focusing on loneliness, depressive symptoms and life satisfaction.

Design: A two-armed, nonblinded, randomised control trial with repeated follow-ups, of N = 153 participants at baseline allocated to an intervention (n = 80) and control (n = 73) group.

Method: Inclusion criteria were the following: ≥65 years of age, living in ordinary housing, in need of assistance in two or more self-reported activities of daily living, having at least two hospital admissions or at least four visits in outpatient care 12 months prior to enrolment. Case managers (nurses and physiotherapists) provided an intervention of general case management, general information, specific information and continuity and safety. The intervention ranged over 12 months with one or more home visit(s) being conducted per month. An intention-to-treat analysis was applied for the primary outcomes of loneliness, depressive symptoms and life satisfaction, along with complete case and sensitivity analyses.

Results: During the trial period n = 12 died and n = 33 dropped out. No significant difference was found between the groups at baseline regarding sociodemographic characteristics, subjective health or primary outcomes. The intention-to-treat analysis did not result in any significant effects for the primary outcomes at any of the follow-ups (6 and 12 months). The complete case analysis resulted in a significant difference in favour of the intervention regarding loneliness (RR = 0.49, p = 0.028) and life satisfaction (ES = 0.41, p = 0.028) at 6 months and for depressive symptoms (ES = 0.47, p = 0.035) at 12 months.

Conclusions: The use of case management for frail older people did not result in clear favourable effects for the primary outcomes. However, the study indicates that case management may be beneficial in terms of these outcomes. Due to the complexity of the outcomes, an elaboration of the components and assessments is suggested.

Keywords: case management; community health services; depression; frail elderly; life satisfaction; loneliness; nursing; randomised controlled trial.