Life In The Slower Lane

Here is the structured PICO analysis for the sixty-fourth article you uploaded:

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Full Title (verbatim and exact):

“Evidence of what works to support and sustain care at home for people with dementia: a literature review with a systematic approach”

Dawson A, Bowes A, Kelly F, Velzke K, Ward R

BMC Geriatrics (2015); 15:59

DOI: 10.1186/s12877-015-0053-9

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Type of Article:

Systematic literature review with thematic synthesis and quality appraisal

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PICO Analysis:

Population:

• People with dementia living at home and their family or informal carers
• Includes international studies, with a focus on community-based care in high-income countries
• Targeted interventions designed to prevent hospitalisation, sustain independence, and support carers

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Intervention:

Varied community-based services and supports intended to help people with dementia remain at home, including:

• Early intervention and post-diagnostic support
• Domiciliary care, community nursing, day services
• Rapid response teams, reablement, and medication management
• Support for carers (respite, education, coping strategies)
• Technological supports (telehealth, assistive devices)
• Multidisciplinary, integrated care models
• Self-directed funding models (e.g. individual budgets) 

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Comparator:

• No formal comparator group; this is a narrative evidence synthesis
• Studies compared interventions to usual care, pre/post design, or non-intervention groups depending on study type

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Outcome:

1. Person-centred outcomes:

• Outcomes included:
  • Delayed admission to residential care
  • Improved symptom management
  • Carer wellbeing, reduced carer burden
  • Greater autonomy, personhood, and social connection
• Evidence quality was highly variable: only 56/131 studies rated as high quality
• Few studies prioritised outcomes from the perspective of people with dementia themselves 

2. Process outcomes:

• Stronger evidence for:
  • Flexible, person-centred, multidisciplinary interventions
  • Integration of support across health and social care
  • Cognitive stimulation, cognitive rehabilitation, and carer education
• Gaps in evidence included:
  • Uptake of self-directed support
  • Evaluation of rapid response teams
  • Night-time care, technology use, and support for those without informal carers

3. Health system outcomes:

• Inconsistent or absent data on hospitalisation, ED visits, or cost-effectiveness
• Some indications that multi-component interventions may delay institutionalisation and reduce costs
• Respite care had modest impact on carer burden, but no clear benefit in delaying institutionalisation 

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Summary Conclusion:

This systematic review found that many policy-driven initiatives to support care at home for people with dementialack a robust evidence base. While multicomponent, flexible, and person-centred interventions show promise—particularly those supporting both the person and their carer—the quality and generalisability of evidence is limited. Critical gaps exist around equity of access, support for people without carers, and effective coordination of services. There is an urgent need for theory-driven, methodologically rigorous studies that prioritise outcomes important to people living with dementia and that reflect the real-world complexity of home-based care.

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