Australia’s population is ageing, and as it does the prevalence of dementia will increase. By 2056 over a million people are anticipated to be living with dementia.
Dementia leads to significant disability in later life. Due to its disabling effects, people with dementia are at greater risk of placement in residential care. Over half of those in residential care in Australia have dementia.
Most Australians prefer to age in place rather than in residential care and supporting them at home could also reduce governments’ aged care costs.
The role of carers is crucial if older people with dementia are to stay at home, but caring for a person with dementia at home can be demanding. Governments fund a range of supports to assist them in this role. Keeping older people with dementia at home is only one of a range of objectives in providing these supports.
This review considers what works to support carers of older people with dementia to prevent or delay entry into residential aged care. It identified 44 interventions (most from overseas) that supported carers of people with dementia, of which 26 were from studies assessed as high quality and so were the focus of the analysis.
Interventions that support carers of older people with dementia show limited effectiveness in achieving the outcome of preventing or delaying entry into residential care. Of the 26 interventions in high-quality studies, only three were found to be effective. Two involved counselling and the other involved case management.
None of the effective interventions are considered appropriate for adoption at this stage for the purpose of preventing or delaying entry into residential aged care. The overall evidence of effectiveness for the counselling interventions was inconclusive as some adaptations were ineffective. But there may be value in further testing. One adaptation had success in the Australian context albeit with important caveats. The case management intervention had several context-specific aspects that limit its transferability to Australia.
Overall, why some interventions were effective in delaying or preventing entry to residential care and others were not is unclear. The interventions often have multiple components, making it hard to isolate the characteristics that influence residential care placement. In addition, many of the components in effective interventions also existed in those that were not. And context — in relation to place and time — matters.
Reducing the risk and delaying the progression of dementia may be a more fruitful avenue to prevent or delay entry into residential care than interventions to support carers.
But the finding of limited effectiveness of interventions to support carers does not suggest that dementia-related funding for carer services, resources and research should be reduced. There are gaps in the research (in particular, studies for respite services). And supporting carers of people with dementia may have important benefits beyond keeping the person with dementia at home.