Is case management effective in reducing the risk of unplanned hospital admissions for older people? A systematic review and meta-analysis

Objective The aim of this study was to investigate the effectiveness of community-based case management in reducing hospital admissions for older people. Methods Five databases were searched from inception to March 2018. Trials were included if: (1) participants were community-dwelling adults aged ≥65 years; (2) intervention was community-based case management for ≥3 months; (3) outcomes related to hospital admissions; and (4) the design included a control group. The quality of evidence was independently assessed by two reviewers using the Physiotherapy Evidence Database (PEDro) scale and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Data were analysed descriptively and using meta-analyses where possible. Results Nine trials (n=5468 participants) were included in the analysis. Meta-analysis found community-based case management did not reduce hospital admissions (standard mean difference –0.09; 95% confidence interval (CI) –0.27, 0.10), but did reduce emergency department (ED) presentations (mean difference –0.26; 95% CI –0.51, –0.01). Conclusion Community-based case management intervention may be effective in reducing ED presentations for older people. What is known about the topic? Although community-based case management is common in Australia, little is known about its effectiveness in reducing healthcare utilisation for community-dwelling older people. What does this paper add? The results indicate that community-based case management may decrease the number of ED presentations among older people. What are the implications for practitioners? Patients with high ED presentation rates may benefit from community-based case management to reduce the number of unnecessary ED presentations.

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Faculty Opinions recommendation of Smoking and all-cause mortality in older people: systematic review and meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717447809.792952845 ◽

2012 ◽

Author(s):

Nico van Zandwijk

Keyword(s):

Systematic Review ◽

Older People ◽

Meta Analysis ◽

All Cause Mortality

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Efficacy of conservative therapy in older people with nonspecific low back pain: A systematic review with meta-analysis and GRADE recommendations

Archives of Gerontology and Geriatrics ◽

10.1016/j.archger.2020.104177 ◽

2020 ◽

Vol 90 ◽

pp. 104177 ◽

Cited By ~ 2

Author(s):

Lorena K.B. Amaral ◽

Mateus B. Souza ◽

Mariana G.M. Campos ◽

Vanessa A. Mendonça ◽

Alessandra Bastone ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Older People ◽

Conservative Therapy ◽

Meta Analysis ◽

Low Back

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Health promotion interventions for community-dwelling older people with mild or pre-frailty: a systematic review and meta-analysis

BMC Geriatrics ◽

10.1186/s12877-017-0547-8 ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 37

Author(s):

Rachael Frost ◽

Celia Belk ◽

Ana Jovicic ◽

Federico Ricciardi ◽

Kalpa Kharicha ◽

...

Keyword(s):

Systematic Review ◽

Health Promotion ◽

Older People ◽

Meta Analysis ◽

Community Dwelling ◽

Community Dwelling Older People ◽

Health Promotion Interventions

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Study protocol of a systematic review and qualitative evidence synthesis using two different approaches: Healthcare related needs and desires of older people with post-stroke aphasia

BMJ Open ◽

10.1136/bmjopen-2020-039348 ◽

2021 ◽

Vol 11 (4) ◽

pp. e039348

Author(s):

Nadine Janis Pohontsch ◽

Thorsten Meyer ◽

Yvonne Eisenmann ◽

Maria-Inti Metzendorf ◽

Verena Leve ◽

...

Keyword(s):

Systematic Review ◽

Older People ◽

Evidence Synthesis ◽

Meta Analysis ◽

Research Question ◽

Treatment Success ◽

Qualitative Studies ◽

Qualitative Evidence Synthesis ◽

Healthcare Needs ◽

Qualitative Evidence

IntroductionStroke is a frequent disease in the older population of Western Europe with aphasia as a common consequence. Aphasia is known to impede targeting treatment to individual patients’ needs and therefore may reduce treatment success. In Germany, the postacute care of patients who had stroke is provided by different healthcare institutions of different sectors (rehabilitation, nursing and primary care) with substantial difficulties to coordinate services. We will conduct two qualitative evidence syntheses (QESs) aiming at exploring distinct healthcare needs and desires of older people living with poststroke aphasia. We thereby hope to support the development of integrated care models based on needs of patients who are very restricted to communicate them. Since various methods of QESs exist, the aim of the study embedding the two QESs was to determine if findings differ according to the approach used.Methods and analysisWe will conduct two QESs by using metaethnography (ME) and thematic synthesis (ThS) independently to synthesise the findings of primary qualitative studies. The main differences between these two methods are the underlying epistemologies (idealism (ME) vs realism (ThS)) and the type of research question (emerging (ME) vs fixed (ThS)).We will search seven bibliographical databases. Inclusion criteria comprise: patients with poststroke aphasia, aged 65 years and older, studies in German/English, all types of qualitative studies concerning needs and desires related to healthcare or the healthcare system. The protocol was registered in the International Prospective Register of Systematic Reviews, follows Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines and includes three items from the Enhancing Transparency in Reporting the synthesis of Qualitative Research checklist.Ethics and disseminationEthical approval is not required. Findings will be published in a peer-reviewed journal and presented on national conferences.

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Effectiveness of Oral Nutritional Supplements on Older People with Anorexia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Nutrients ◽

10.3390/nu13030835 ◽

2021 ◽

Vol 13 (3) ◽

pp. 835

Author(s):

Mengqi Li ◽

Si Zhao ◽

Shuang Wu ◽

Xiufen Yang ◽

Hui Feng

Keyword(s):

Systematic Review ◽

Body Weight ◽

Older People ◽

Energy Intake ◽

Meta Analysis ◽

Nutritional Supplements ◽

The Elderly ◽

Randomized Controlled ◽

Oral Nutritional Supplements ◽

Positive Effect

Background: Nutrition plays an important role in maintaining the overall health of older people. Inadequate intake may lead to impaired body function, higher morbidity, and mortality. Oral nutritional supplements (ONS) showed positive effect on the nutritional status of the elderly; however, systematic evidence is currently lacking on the effect of ONS on the elderly with anorexia. Aims: The current systematic review and meta-analysis included randomized controlled trial (RCT) articles to investigate the effectiveness of ONS on the main aspects of anorexia of aging (AA). Methods: By using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, researchers independently searched PubMed/MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library, China National Knowledge Infrastructure (CNKI) and other gray literature resources for publications that met the inclusion criteria by October 2020. The Cochrane Risk of Bias Tools were used for quality assessment. The inverse-variance method was used for the fixed model (FM) while the DerSimonian–Laird method was used for the random model (RM). Respective 95% confidence intervals (95% CIs), mean difference (MD) or standardized mean difference (SMD) was used for indices in terms of effect size (ES). Results: 2497 records were found through the systematic search, while 17 RCTs (n = 1204) were included, with a mean age of 81.9 years (range: 74–87 years). Supplementation occurred in the morning, mid-day, and evening, while the times varied from one to three times a day. The results of meta-analysis showed that, generally, ONS had a positive effect on the overall appetite, MD = 0.18, 95% CI (0.03, 0.33), p = 0.02, and consumption, MD = 1.43, 95% CI (0.01, 2.86), p = 0.05; but not significant in terms of other aspects of appetite: hunger, p = 0.73; fullness, p = 0.60; desire to eat, p = 0.80; preoccupation, p = 0.15. Additionally, it showed an increase in the overall energy intake, SMD = 0.46, 95% CI (0.29, 0.63), p < 0.001, in protein intake, SMD = 0.59, 95% CI (0.16, 1.02), p = 0.007, and in fat intake, MD = 3.47, 95% CI (1.98, 4.97), p < 0.001, while no positive effect was found on carbohydrates intake, p = 0.06. Significance differences were also found in the body weight, SMD = 0.53, 95% CI (0.41, 0.65), p < 0.001, and body mass index (BMI), MD = 0.53, 95% CI (0.12, 0.95), p = 0.01. Moreover, subgroup analyses were conducted according to the nutrient density with no positive results showed except for the low-density ONS on overall energy intake. Conclusions: The results of the present study indicated that ONS had beneficial effects on overall appetite, energy intake, body weight and BMI.

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