EHealth in geriatric rehabilitation: a systematic review of effectiveness, feasibility and usability (Preprint)

BACKGROUND eHealth has the potential to improve outcomes in older adults receiving geriatric rehabilitation. However, evidence on (cost)effectiveness in post-acute geriatric rehabilitation is scarce, and the successful implementation and use of eHealth in geriatric rehabilitation is not self-evident. OBJECTIVE The aim of this systematic review is to assess the effectiveness, usability and feasibility of eHealth interventions in older adults in geriatric rehabilitation. METHODS Seven databases were searched for randomized controlled trials, non-randomized studies, quantitative descriptive studies, qualitative research and mixed methods studies that applied eHealth interventions during geriatric rehabilitation. Included studies investigated effectiveness, usability and/or feasibility of eHealth in older patients with a mean age of ≥70 who received geriatric rehabilitation. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT) and a narrative synthesis was conducted using a Harvest plot. RESULTS In total 34 were selected, with clinical heterogeneity across studies, and high exclusion rates reported in 7studies. Outcomes related to participation and usability were infrequently reported. In 16 studies eHealth was found to be at least as effective as non-eHealth interventions (73% of the included studies with a control group), 6 studies found eHealth interventions to be more effective than non-eHealth interventions (27%), and 2 studies reported beneficial outcomes in favor of the non-eHealth interventions (9%). Overall, the identified studies showed that eHealth is often feasible and can potentially improve rehabilitation outcomes, especially in combination with another (non)eHealth intervention. Simple eHealth interventions were more likely to be feasible for older patients receiving geriatric rehabilitation. CONCLUSIONS Current evidence on eHealth in older patients receiving geriatric rehabilitation is diverse, making it challenging to compare outcomes and draw conclusions. Furthermore, a lack of evidence on usability might hamper the implementation of eHealth. eHealth applications in geriatric rehabilitation show promise but more research is required, including research with a focus on usability and participation

Download Full-text

Potential Benefits of Exergaming for Cognition and Dual-Task Function in Older Adults: A Systematic Review

Journal of Aging and Physical Activity ◽

10.1123/japa.2014-0267 ◽

2016 ◽

Vol 24 (2) ◽

pp. 332-336 ◽

Cited By ~ 27

Author(s):

Elisa F. Ogawa ◽

Tongjian You ◽

Suzanne G. Leveille

Keyword(s):

Systematic Review ◽

Older Adults ◽

Cognitive Function ◽

Physical Exercise ◽

Dual Task ◽

Current Evidence ◽

Control Group ◽

Randomized Controlled ◽

Randomized Controlled Studies ◽

Research Findings

This paper provides a systematic review of current research findings using exergaming as a treatment for improving cognition and dual-task function in older adults. A literature search was conducted to collect exergaming intervention studies that were either randomized controlled or uncontrolled studies. Of the seven identified studies (five randomized controlled studies and two uncontrolled studies), three studies focused on cognitive function alone, two studies focused on dual-task function alone, and two studies measured both cognitive function and dual-task function. Current evidence supports that exergaming improves cognitive function and dual-task function, which potentially leads to fall prevention. However, it is unclear whether exergaming, which involves both cognitive input and physical exercise, has additional benefits compared with traditional physical exercise alone. Further studies should include traditional exercise as a control group to identify these potential, additional benefits.

Download Full-text

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.

Download Full-text

Dose-Response Relationship between Endurance Training Prescription Variables and Increases in Aerobic Performance of Healthy and Unhealthy Middle and Very Old Individuals Aged 70 Years and Older: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Life ◽

10.3390/life11020121 ◽

2021 ◽

Vol 11 (2) ◽

pp. 121

Author(s):

Sarah Cheour ◽

Chouaib Cheour ◽

Nicola Luigi Bragazzi ◽

Liye Zou ◽

Armin H. Paravlic ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Endurance Training ◽

Dose Response ◽

Meta Analysis ◽

Aerobic Performance ◽

Control Group ◽

Very Old ◽

Randomized Controlled ◽

Randomized Controlled Studies

Background: The objectives of this systematic review and meta-analysis were to quantify the effectiveness of endurance training (ET) on aerobic performance (i.e., peak oxygen uptake (VO2peak)) in healthy and unhealthy middle and very old adults aged 70 years and older, and to provide dose–response relationships of training prescription variables (in terms of frequency, and volume). Methods: Several scholarly databases (i.e., PubMed/MEDLINE, SpringerLink, ScienceDirect Journals, and Taylor & Francis Online—Journals) were searched, identifying randomized controlled studies that investigated the effectiveness of ET on VO2peak in older adults. Standardized mean differences (SMD) were calculated. Results: In terms of changes differences between experimental and control group, ET produced significant large effects on VO2peak performance (SMD = 2.64 (95%CI 0.97–4.31)). The moderator analysis revealed that “health status” variable moderated ET effect onVO2peak performance. More specifically, ET produced larger SMD magnitudes on VO2peak performance in healthy compared with unhealthy individuals. With regard to the dose–response relationships, findings from the meta-regression showed that none of the included training prescription variables predicted ET effects on VO2peak performance. Conclusions: ET is an effective mean for improving aerobic performance in healthy older adults when compared with their unhealthy counterparts.

Download Full-text

The evidence for assessing frailty and sarcopenia in an acute medical unit: a systematic review

Acute Medicine Journal ◽

10.52964/amja.0841 ◽

2021 ◽

Vol 20 (1) ◽

pp. 48-67

Author(s):

Vicky Kamwa ◽

◽

Adam Seccombe ◽

Elizabeth Sapey ◽

◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Risk Of Bias ◽

Current Evidence ◽

Unplanned Admission ◽

Medical Unit ◽

Targeted Interventions ◽

Acute Medical Unit ◽

Study Heterogeneity ◽

Clinical Adoption

Background/objectives: A systematic review was conducted to assess if frailty and sarcopenia were associated with poorer outcomes in older adults admitted to an acute medical unit (AMU). Methods: Eligible studies included older adults with an unplanned admission to an AMU and included a measure of frailty or sarcopenia, completed within 72 hours of admission. Risk of bias was assessed. Results: Of 1659 identified articles, 16 were included (4 on sarcopenia and 12 on frailty). There was significant study heterogeneity. Overall, frailty and sarcopenia were associated with worse outcomes. Targeted interventions appeared to improve outcomes. Conclusion: Current evidence suggests some benefit in screening older adults admitted to an AMU for frailty and sarcopenia. However, further studies are required before clinical adoption.

Download Full-text

Neurobiological findings associated with high cognitive performance in older adults: a systematic review

International Psychogeriatrics ◽

10.1017/s1041610218000431 ◽

2018 ◽

Vol 30 (12) ◽

pp. 1813-1825 ◽

Cited By ~ 2

Author(s):

Wyllians Vendramini Borelli ◽

Lucas Porcello Schilling ◽

Graciane Radaelli ◽

Luciana Borges Ferreira ◽

Leonardo Pisani ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Cognitive Performance ◽

Anterior Cingulate ◽

Control Group ◽

High Performing ◽

High Performers ◽

Positron Emission ◽

Definition Of ◽

Molecular Brain

ABSTRACTObjectives:to perform a comprehensive literature review of studies on older adults with exceptional cognitive performance.Design:We performed a systematic review using two major databases (MEDLINE and Web of Science) from January 2002 to November 2017.Results:Quantitative analysis included nine of 4,457 studies and revealed that high-performing older adults have global preservation of the cortex, especially the anterior cingulate region, and hippocampal volumes larger than normal agers. Histological analysis of this group also exhibited decreased amyloid burden and neurofibrillary tangles compared to cognitively normal older controls. High performers that maintained memory ability after three years showed reduced amyloid positron emission tomography at baseline compared with high performers that declined. A single study on blood plasma found a set of 12 metabolites predicting memory maintenance of this group.Conclusion:Structural and molecular brain preservation of older adults with high cognitive performance may be associated with brain maintenance. The operationalized definition of high-performing older adults must be carefully addressed using appropriate age cut-off and cognitive evaluation, including memory and non-memory tests. Further studies with a longitudinal approach that include a younger control group are essential.

Download Full-text

Effectiveness of interventions to alleviate emergency department crowding by older adults: a systematic review

BMC Emergency Medicine ◽

10.1186/s12873-019-0288-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Gijs Hesselink ◽

Özcan Sir ◽

Yvonne Schoon

Keyword(s):

Systematic Review ◽

Older Adults ◽

Emergency Department ◽

Older Patients ◽

Elderly Care ◽

Rapid Assessment ◽

Experimental Studies ◽

Design Quality ◽

Content Type ◽

Ed Crowding

Abstract Background The growing demand for elderly care often exceeds the ability of emergency department (ED) services to provide quality of care within reasonable time. The purpose of this systematic review is to assess the effectiveness of interventions on reducing ED crowding by older patients, and to identify core characteristics shared by successful interventions. Methods Six major biomedical databases were searched for (quasi)experimental studies published between January 1990 and March 2017 and assessing the effect of interventions for older patients on ED crowding related outcomes. Two independent reviewers screened and selected studies, assessed risk of bias and extracted data into a standardized form. Data were synthesized around the study setting, design, quality, intervention content, type of outcome and observed effects. Results Of the 16 included studies, eight (50%) were randomized controlled trials (RCTs), two (13%) were non-RCTs and six (34%) were controlled before-after (CBA) studies. Thirteen studies (81%) evaluated effects on ED revisits and four studies (25%) evaluated effects on ED throughput time. Thirteen studies (81%) described multicomponent interventions. The rapid assessment and streaming of care for older adults based on time-efficiency goals by dedicated staff in a specific ED unit lead to a statistically significant decrease of ED length of stay (LOS). An ED-based consultant geriatrician showed significant time reduction between patient admission and geriatric review compared to an in-reaching geriatrician. Conclusion Inter-study heterogeneity and poor methodological quality hinder drawing firm conclusions on the intervention’s effectiveness in reducing ED crowding by older adults. More evidence-based research is needed using uniform and valid effect measures. Trial registration The protocol is registered with the PROSPERO International register of systematic reviews: ID = CRD42017075575).

Download Full-text

Does the Formulation of Oral Solid Dosage Forms Affect Acceptance and Adherence in Older Patients? A Mixed Methods Systematic Review

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2020.01.108 ◽

2020 ◽

Vol 21 (8) ◽

pp. 1015-1023.e8 ◽

Cited By ~ 3

Author(s):

Zakia B. Shariff ◽

Dania T. Dahmash ◽

Daniel J. Kirby ◽

Shahrzad Missaghi ◽

Ali Rajabi-Siahboomi ◽

...

Keyword(s):

Systematic Review ◽

Mixed Methods ◽

Older Patients ◽

Dosage Forms ◽

Solid Dosage Forms ◽

Solid Dosage

Download Full-text

The effect of ageing on presentation, management and outcomes in degenerative cervical myelopathy: a systematic review

Age and Ageing ◽

10.1093/ageing/afaa236 ◽

2020 ◽

Author(s):

Ben Grodzinski ◽

Rory Durham ◽

Oliver Mowforth ◽

Daniel Stubbs ◽

Mark R N Kotter ◽

...

Keyword(s):

Systematic Review ◽

Functional Status ◽

Cervical Myelopathy ◽

Older Patients ◽

Meta Analysis ◽

Current Evidence ◽

Clinical Aspects ◽

Similar Amount ◽

Degenerative Cervical Myelopathy ◽

The Impact

Abstract Objective Degenerative cervical myelopathy (DCM) is a disabling neurological condition. The underlying degenerative changes are known to be more common with age, but the impact of age on clinical aspects of DCM has never been synthesised. The objective of this study is to determine whether age is a significant predictor in three domains—clinical presentation, surgical management and post-operative outcomes of DCM. Methods a systematic review of the Medline and Embase databases (inception to 12 December 2019), registered with PROSPERO (CRD42019162077) and reported in accordance with preferred reporting items of systematic reviews and meta-analysis (PRISMA) guidelines, was conducted. The inclusion criteria were full text articles in English, evaluating the impact of age on clinical aspects of DCM. Results the initial search yielded 2,420 citations, of which 206 articles were eventually included. Age was found to be a significant predictor in a variety of measures. Within the presentation domain, older patients have a worse pre-operative functional status. Within the management domain, older patients are more likely to undergo posterior surgery, with more levels decompressed. Within the outcomes domain, older patients have a worse post-operative functional status, but a similar amount of improvement in functional status. Because of heterogenous data reporting, meta-analysis was not possible. Conclusion the current evidence demonstrates that age significantly influences the presentation, management and outcomes of DCM. Although older patients have worse health at all individual timepoints, they experience the same absolute benefit from surgery as younger patients. This finding is of particular relevance when considering the eligibility of older patients for surgery.

Download Full-text

Effects of aerobic exercise in the treatment of older adults with chronic musculoskeletal pain: a protocol of a systematic review

Systematic Reviews ◽

10.1186/s13643-019-1165-7 ◽

2019 ◽

Vol 8 (1) ◽

Author(s):

Naiane Teixeira Bastos de Oliveira ◽

Irlei dos Santos ◽

Gisela Cristiane Miyamoto ◽

Cristina Maria Nunes Cabral

Keyword(s):

Systematic Review ◽

Older Adults ◽

Aerobic Exercise ◽

Musculoskeletal Pain ◽

Included Study ◽

Chronic Musculoskeletal Pain ◽

Current Evidence ◽

Controlled Trials ◽

Cochrane Central Register ◽

And Function

Abstract Background Chronic musculoskeletal pain affects the quality of life of older adults by interfering in their ability to perform activities of daily living. Aerobic exercise programs have been used in the treatment of various health conditions, including musculoskeletal disorders. However, there is still little evidence on the effects of aerobic exercise for the treatment of older adults with chronic musculoskeletal pain. Thus, the objective of this study is to assess the effects of aerobic exercise in improving pain and function of older adults with chronic pain as a consequence of different chronic musculoskeletal conditions. Methods The databases to be used in the search are PubMed, EMBASE, CINAHL, PEDro, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials that used aerobic exercise in the treatment of older adults with chronic musculoskeletal pain will be included. Primary outcomes will be pain and function. We will use the PEDro scale to evaluate the methodological quality and statistical description of each included study, and the strength of the recommendations will be summarized using GRADE. Discussion The results of this systematic review will provide a synthesis of the current evidence on the effects of aerobic exercise in the treatment of older adults with chronic musculoskeletal pain. In addition, this information can help health professionals in decision-making about the use of aerobic exercise in the treatment of older adults with chronic musculoskeletal pain. Ethics and dissemination This systematic review was recorded prospectively, and the results will be part of a doctoral thesis to be published in a peer-reviewed international journal and possibly presented at international conferences. Systematic review registration PROSPERO, CRD42019118903.

Download Full-text

Can in-hospital or post discharge caregiver involvement increase functional performance of older patients? A systematic review

BMC Geriatrics ◽

10.1186/s12877-020-01769-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Margaretha van Dijk ◽

Jasmien Vreven ◽

Mieke Deschodt ◽

Geert Verheyden ◽

Jos Tournoy ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Older Patients ◽

Functional Performance ◽

Care Pathway ◽

Intervention Group ◽

Post Discharge ◽

Home Setting ◽

Randomized Controlled ◽

Caregiver Involvement

Abstract Background Regaining pre-hospitalization activity levels is only achieved in 30–50% of older patients. Extra physiotherapy time has been proven to improve functional outcome and shorten length of stay, but is costly. Considering their key role in caring for older people, involving informal caregivers in rehabilitation might further improve functional performance. Aim To determine if in-hospital or post discharge caregiver involvement can increase functional performance in older adults. The secondary aim was to determine if caregiver involvement can influence, quality of life of patient and caregiver, medical costs, readmission rate, discharge location, and mortality. Design Systematic review with narrative synthesis. Methods The electronic bibliographic databases MEDLINE, Embase, CINAHL, Cochrane and Web of Science were searched for (quasi) experimental and observational studies, with the following inclusion criteria; caregiver involvement regarding functional performance, mean age over 65 years, admitted to a hospital unit and subsequently discharged to their home setting. Risk of bias was assessed with the Rob 2 (randomized trials) and the ROBINS-1 tool (non-randomized studies). Results Eight studies of an initial 4683 were included: four randomized controlled trials, one prospective cohort study, one non-randomized controlled trial, one subgroup analysis of an RCT and one prospective pre-post study. All but one study included patients with stroke. Three types of caregiver interventions could be distinguished: a care pathway (inclusion of caregivers in the process of care), education on stroke and teaching of bed-side handling-skills, and caregiver-mediated exercises. The one study evaluating the care pathway reported 24.9% more returns home in the intervention group. Studies evaluating the effect of education and bed-side handling-skills reported higher effect sizes for several outcomes with increasing session frequency. All studies with caregiver-mediated exercises showed beneficial effects on functional performance, immediately after the intervention and within 3 months follow-up. Conclusion The findings of this review suggest that involvement of caregivers in the rehabilitation of older adults leads to better functional performance up to 3 months after initiation. However, evidence is low and mainly focusing on stroke.

Download Full-text