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Complex interventions for improving independent living and quality of life amongst community-dwelling older adults: a systematic review and meta-analysis

BACKGROUND: community-based complex interventions for older adults have a variety of names, including Comprehensive Geriatric Assessment, but often share core components such as holistic needs assessment and care planning. OBJECTIVE: to summarise evidence for the components and effectiveness of comm...

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Autores principales: Ho, Leonard, Malden, Stephen, McGill, Kris, Shimonovich, Michal, Frost, Helen, Aujla, Navneet, Ho, Iris S-S, Shenkin, Susan D, Hanratty, Barbara, Mercer, Stewart W, Guthrie, Bruce
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10378722/
https://www.ncbi.nlm.nih.gov/pubmed/37505991
http://dx.doi.org/10.1093/ageing/afad132
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author Ho, Leonard
Malden, Stephen
McGill, Kris
Shimonovich, Michal
Frost, Helen
Aujla, Navneet
Ho, Iris S-S
Shenkin, Susan D
Hanratty, Barbara
Mercer, Stewart W
Guthrie, Bruce
author_facet Ho, Leonard
Malden, Stephen
McGill, Kris
Shimonovich, Michal
Frost, Helen
Aujla, Navneet
Ho, Iris S-S
Shenkin, Susan D
Hanratty, Barbara
Mercer, Stewart W
Guthrie, Bruce
author_sort Ho, Leonard
collection PubMed
description BACKGROUND: community-based complex interventions for older adults have a variety of names, including Comprehensive Geriatric Assessment, but often share core components such as holistic needs assessment and care planning. OBJECTIVE: to summarise evidence for the components and effectiveness of community-based complex interventions for improving older adults’ independent living and quality of life (QoL). METHODS: we searched nine databases and trial registries to February 2022 for randomised controlled trials comparing complex interventions to usual care. Primary outcomes included living at home and QoL. Secondary outcomes included mortality, hospitalisation, institutionalisation, cognitive function and functional status. We pooled data using risk ratios (RRs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs). RESULTS: we included 50 trials of mostly moderate quality. Most reported using holistic assessment (94%) and care planning (90%). Twenty-seven (54%) involved multidisciplinary care, with 29.6% delivered mainly by primary care teams without geriatricians. Nurses were the most frequent care coordinators. Complex interventions increased the likelihood of living at home (RR 1.05; 95% CI 1.00–1.10; moderate-quality evidence) but did not affect QoL. Supported by high-quality evidence, they reduced mortality (RR 0.86; 95% CI 0.77–0.96), enhanced cognitive function (SMD 0.12; 95% CI 0.02–0.22) and improved instrumental activities of daily living (ADLs) (SMD 0.11; 95% CI 0.01–0.21) and combined basic/instrumental ADLs (SMD 0.08; 95% CI 0.03–0.13). CONCLUSIONS: complex interventions involving holistic assessment and care planning increased the chance of living at home, reduced mortality and improved cognitive function and some ADLs.
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spelling pubmed-103787222023-07-29 Complex interventions for improving independent living and quality of life amongst community-dwelling older adults: a systematic review and meta-analysis Ho, Leonard Malden, Stephen McGill, Kris Shimonovich, Michal Frost, Helen Aujla, Navneet Ho, Iris S-S Shenkin, Susan D Hanratty, Barbara Mercer, Stewart W Guthrie, Bruce Age Ageing Systematic Review BACKGROUND: community-based complex interventions for older adults have a variety of names, including Comprehensive Geriatric Assessment, but often share core components such as holistic needs assessment and care planning. OBJECTIVE: to summarise evidence for the components and effectiveness of community-based complex interventions for improving older adults’ independent living and quality of life (QoL). METHODS: we searched nine databases and trial registries to February 2022 for randomised controlled trials comparing complex interventions to usual care. Primary outcomes included living at home and QoL. Secondary outcomes included mortality, hospitalisation, institutionalisation, cognitive function and functional status. We pooled data using risk ratios (RRs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs). RESULTS: we included 50 trials of mostly moderate quality. Most reported using holistic assessment (94%) and care planning (90%). Twenty-seven (54%) involved multidisciplinary care, with 29.6% delivered mainly by primary care teams without geriatricians. Nurses were the most frequent care coordinators. Complex interventions increased the likelihood of living at home (RR 1.05; 95% CI 1.00–1.10; moderate-quality evidence) but did not affect QoL. Supported by high-quality evidence, they reduced mortality (RR 0.86; 95% CI 0.77–0.96), enhanced cognitive function (SMD 0.12; 95% CI 0.02–0.22) and improved instrumental activities of daily living (ADLs) (SMD 0.11; 95% CI 0.01–0.21) and combined basic/instrumental ADLs (SMD 0.08; 95% CI 0.03–0.13). CONCLUSIONS: complex interventions involving holistic assessment and care planning increased the chance of living at home, reduced mortality and improved cognitive function and some ADLs. Oxford University Press 2023-07-26 /pmc/articles/PMC10378722/ /pubmed/37505991 http://dx.doi.org/10.1093/ageing/afad132 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Systematic Review
Ho, Leonard
Malden, Stephen
McGill, Kris
Shimonovich, Michal
Frost, Helen
Aujla, Navneet
Ho, Iris S-S
Shenkin, Susan D
Hanratty, Barbara
Mercer, Stewart W
Guthrie, Bruce
Complex interventions for improving independent living and quality of life amongst community-dwelling older adults: a systematic review and meta-analysis
title Complex interventions for improving independent living and quality of life amongst community-dwelling older adults: a systematic review and meta-analysis
title_full Complex interventions for improving independent living and quality of life amongst community-dwelling older adults: a systematic review and meta-analysis
title_fullStr Complex interventions for improving independent living and quality of life amongst community-dwelling older adults: a systematic review and meta-analysis
title_full_unstemmed Complex interventions for improving independent living and quality of life amongst community-dwelling older adults: a systematic review and meta-analysis
title_short Complex interventions for improving independent living and quality of life amongst community-dwelling older adults: a systematic review and meta-analysis
title_sort complex interventions for improving independent living and quality of life amongst community-dwelling older adults: a systematic review and meta-analysis
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10378722/
https://www.ncbi.nlm.nih.gov/pubmed/37505991
http://dx.doi.org/10.1093/ageing/afad132
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