Geriatric assessment for older adults admitted to the emergency department: A systematic review and meta-analysis

ABSTRACTObjectiveDetection of delirium in hospitalised older adults is recommended in national and international guidelines. The 4 ‘A’s Test (4AT) is a short (<2 min) instrument for delirium detection that is used internationally as a standard tool in clinical practice. We performed a systematic review and meta-analysis of diagnostic test accuracy of the 4AT for delirium detection.MethodsWe searched MEDLINE, EMBASE, PsycINFO, CINAHL, clinicaltrials.gov and the Cochrane Central Register of Controlled Trials, from 2011 (year of 4AT release on the website www.the4AT.com) until 21 December 2019. Inclusion criteria were: older adults (≥ 65y); diagnostic accuracy study of the 4AT index test when compared to delirium reference standard (standard diagnostic criteria or validated tool). Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled estimates of sensitivity and specificity were generated from a bivariate random effects model.Results17 studies (3702 observations) were included. Settings were acute medicine, surgery, a care home, and the emergency department. Three studies assessed performance of the 4AT in stroke. The overall prevalence of delirium was 24.2% (95% CI 17.8-32.1%; range 10.5-61.9%). The pooled sensitivity was 0.88 (95% CI 0.80-0.93) and the pooled specificity was 0.88 (95% CI 0.82-0.92). Excluding the stroke studies, the pooled sensitivity was 0.86 (95% CI 0.77-0.92) and the pooled specificity was 0.89 (95% CI 0.83-0.93). The methodological quality of studies varied but was moderate to good overall.ConclusionsThe 4AT shows good diagnostic test accuracy for delirium in the 17 available studies. These findings support its use in routine clinical practice in delirium detection.PROSPERO Registration number CRD42019133702.Key pointsThe 4AT is a short delirium assessment tool that is widely used internationally in clinical practice.This systematic review and meta-analysis of diagnostic accuracy studies of the 4AT included 3702 observations in 17 studies from nine countries.Studies recruited from a range of settings including the Emergency Department, and medical, stroke, and surgical wards.The 4AT had a pooled sensitivity of 0.88 and pooled specificity of 0.88.The methodological quality of studies varied but was moderate to good overall.

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A Game a Day Keeps Cognitive Decline Away? A Systematic Review and Meta-Analysis of Commercially-Available Brain Training Programs in Healthy and Cognitively Impaired Older Adults

Neuropsychology Review ◽

10.1007/s11065-021-09515-2 ◽

2021 ◽

Author(s):

Lan Nguyen ◽

Karen Murphy ◽

Glenda Andrews

Keyword(s):

Systematic Review ◽

Older Adults ◽

Cognitive Decline ◽

Training Programs ◽

Meta Analysis ◽

Cognitively Impaired ◽

Brain Training

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The relationship between exposure to PM2.5 and atrial fibrillation in older adults: A systematic review and meta-analysis

The Science of The Total Environment ◽

10.1016/j.scitotenv.2021.147106 ◽

2021 ◽

pp. 147106

Author(s):

Fenghong Wang ◽

Xapkat Ahat ◽

Qingqing Liang ◽

Yuexiao Ma ◽

Mengqi Sun ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Older Adults ◽

Meta Analysis ◽

The Relationship

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Stepping impairment and falls in older adults: A systematic review and meta-analysis of volitional and reactive step tests

Ageing Research Reviews ◽

10.1016/j.arr.2020.101238 ◽

2020 ◽

pp. 101238

Author(s):

Yoshiro Okubo ◽

Daniel Schoene ◽

Maria JD Caetano ◽

Erika M Pliner ◽

Yosuke Osuka ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Meta Analysis ◽

Falls In Older Adults

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Clinical features and outcomes of COVID-19 in older adults: a systematic review and meta-analysis

BMC Geriatrics ◽

10.1186/s12877-021-02261-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sunny Singhal ◽

Pramod Kumar ◽

Sumitabh Singh ◽

Srishti Saha ◽

Aparajit Ballav Dey

Keyword(s):

Systematic Review ◽

Older Adults ◽

Critically Ill ◽

Clinical Features ◽

Older Patients ◽

Clinical Characteristics ◽

Meta Analysis ◽

Severe Infection ◽

Factors Affecting ◽

Pooled Prevalence

Abstract Background Few studies have focused on exploring the clinical characteristics and outcomes of COVID-19 in older patients. We conducted this systematic review and meta-analysis to have a better understanding of the clinical characteristics of older COVID-19 patients. Methods A systematic search of PubMed and Scopus was performed from December 2019 to May 3rd, 2020. Observational studies including older adults (age ≥ 60 years) with COVID-19 infection and reporting clinical characteristics or outcome were included. Primary outcome was assessing weighted pooled prevalence (WPP) of severity and outcomes. Secondary outcomes were clinical features including comorbidities and need of respiratory support. Result Forty-six studies with 13,624 older patients were included. Severe infection was seen in 51% (95% CI– 36-65%, I2–95%) patients while 22% (95% CI– 16-28%, I2–88%) were critically ill. Overall, 11% (95% CI– 5-21%, I2–98%) patients died. The common comorbidities were hypertension (48, 95% CI– 36-60% I2–92%), diabetes mellitus (22, 95% CI– 13-32%, I2–86%) and cardiovascular disease (19, 95% CI – 11-28%, I2–85%). Common symptoms were fever (83, 95% CI– 66-97%, I2–91%), cough (60, 95% CI– 50-70%, I2–71%) and dyspnoea (42, 95% CI– 19-67%, I2–94%). Overall, 84% (95% CI– 60-100%, I2–81%) required oxygen support and 21% (95% CI– 0-49%, I2–91%) required mechanical ventilation. Majority of studies had medium to high risk of bias and overall quality of evidence was low for all outcomes. Conclusion Approximately half of older patients with COVID-19 have severe infection, one in five are critically ill and one in ten die. More high-quality evidence is needed to study outcomes in this vulnerable patient population and factors affecting these outcomes.

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