scholarly journals What Works to Prevent Falls in Community-Dwelling Older Adults? Umbrella Review of Meta-analyses of Randomized Controlled Trials

2015 ◽  
Vol 95 (8) ◽  
pp. 1095-1110 ◽  
Author(s):  
Brendon Stubbs ◽  
Simone Brefka ◽  
Michael D. Denkinger
Keyword(s):  
Older Adults ◽  
Methodological Quality ◽  
Community Dwelling ◽  
Falls Prevention ◽  
Controlled Trials ◽  
Umbrella Review ◽  
Randomized Controlled ◽  
Meta Analyses ◽  
Community Dwelling Older Adults

Background Preventing falls is an international priority. There is a need to synthesize the highest-quality falls prevention evidence in one place for clinicians. Purpose The aim of this study was to conduct an umbrella review of meta-analyses of randomized controlled trials (RCTs) of falls prevention interventions in community-dwelling older adults. Data Sources The MEDLINE, EMBASE, CINAHL, AMED, BNI, PsycINFO, Cochrane Library, PubMed, and PEDro databases were searched. Study Selection Meta-analyses with one pooled analysis containing ≥3 RCTs that investigated any intervention to prevent falls in community-dwelling older adults aged ≥60 years were eligible. Sixteen meta-analyses, representing 47 pooled analyses, were included. Data Extraction Two authors independently extracted data. Data Synthesis Data were narratively synthesized. The methodological quality of the meta-analyses was moderate. Three meta-analyses defined a fall, and 3 reported adverse events (although minor). There is consistent evidence that exercise reduces falls (including the rate, risk, and odds of falling), with 13/14 pooled analyses (93%) from 7 meta-analyses demonstrating a significant reduction. The methodological quality of meta-analyses investigating exercise were medium/high, and effect sizes ranged from 0.87 (relative risk 95% confidence interval=0.81, 0.94; number of studies=18; number of participants=3,568) to 0.39 (rate ratio 95% confidence interval=0.23, 0.66; number of meta-analyses=6). There is consistent evidence that multifactorial interventions reduce falls (5/6, 83% reported significant reduction). There is conflicting evidence regarding the influence of vitamin D supplementation (7/12, 58.3% reported significant reduction). Limitations Meta-analyses often used different methods of analysis, and reporting of key characteristics (eg, participants, heterogeneity, publication bias) was often lacking. There may be some overlap among included meta-analyses. Conclusions There is consistent evidence that exercise and individually tailored multifactorial interventions are effective in reducing falls in community-dwelling older adults.

scholarly journals Related Factors and Clinical Outcomes of Osteosarcopenia: A Narrative Review

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 291
Author(s):  
Tatsuro Inoue ◽  
Keisuke Maeda ◽  
Ayano Nagano ◽  
Akio Shimizu ◽  
Junko Ueshima ◽  
...  
Keyword(s):  
Older Adults ◽  
Longitudinal Studies ◽  
Clinical Outcomes ◽  
Daily Living ◽  
Community Dwelling ◽  
Related Factors ◽  
Cross Sectional ◽  
Meta Analyses ◽  
Community Dwelling Older Adults

Osteopenia/osteoporosis and sarcopenia are common geriatric diseases among older adults and harm activities of daily living (ADL) and quality of life (QOL). Osteosarcopenia is a unique syndrome that is a concomitant of both osteopenia/osteoporosis and sarcopenia. This review aimed to summarize the related factors and clinical outcomes of osteosarcopenia to facilitate understanding, evaluation, prevention, treatment, and further research on osteosarcopenia. We searched the literature to include meta-analyses, reviews, and clinical trials. The prevalence of osteosarcopenia among community-dwelling older adults is significantly higher in female (up to 64.3%) compared to male (8–11%). Osteosarcopenia is a risk factor for death, fractures, and falls based on longitudinal studies. However, the associations between osteosarcopenia and many other factors have been derived based on cross-sectional studies, so the causal relationship is not clear. Few studies of osteosarcopenia in hospitals have been conducted. Osteosarcopenia is a new concept and has not yet been fully researched its relationship to clinical outcomes. Longitudinal studies and high-quality interventional studies are warranted in the future.

Systematic review and meta-analysis of smart-technology vs. face-to-face physical activity interventions in older adults (Preprint)

2022 ◽  
Author(s):  
Cassandra D'Amore ◽  
Julie C Reid ◽  
Matthew Chan ◽  
Samuel Fan ◽  
Amanda Huang ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Community Dwelling ◽  
Smart Technology ◽  
Face To Face ◽  
Meta Analyses ◽  
Community Dwelling Older Adults

BACKGROUND This is a systematic review of randomized controlled trials and a meta-analysis comparing smart-technology to face-to-face physical activity (PA) interventions, in community-dwelling older adults, mean age greater than or equal 60 years. OBJECTIVE To determine the effect of smart-technology interventions compared to face-to-face PA interventions on PA and physical function in older adults. Our secondary outcomes were depression, anxiety, and health-related quality of life. METHODS We searched four electronic databases from inception to February 2021. Two independent reviewers screened titles/abstracts, full texts, and performed data extraction and risk of bias assessments using the Cochrane risk of bias tool. GRADE was used to evaluate the quality of the evidence. We provided a narrative synthesis on all included studies and, where possible, we performed meta-analyses for similar outcomes. RESULTS 19 studies with a total of 3455 patients were included. Random-effects meta-analyses showed that smart-technology interventions resulted in improved step count (mean difference 1440 steps, 95% confidence interval (CI) 500, 2390) and total PA (standardized mean difference 0.17, 95% CI 0.02, 0.32) compared to face-face interventions. The quality of the evidence for the effects of smart-technology interventions was very low based on GRADE criteria. There was no difference between groups for measures of physical function. CONCLUSIONS Interventions that include smart-technology may improve daily step counts by an average of 1440 steps in community dwelling older adults, however the quality of the evidence was very low. Future studies are needed to improve the certainty of results.

scholarly journals The effect of pharmacist-led interventions in optimising prescribing in older adults in primary care: A systematic review

2016 ◽  
Vol 4 ◽  
pp. 205031211665256 ◽  
Author(s):  
David O Riordan ◽  
Kieran A Walsh ◽  
Rose Galvin ◽  
Carol Sinnott ◽  
Patricia M Kearney ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Inappropriate Prescribing ◽  
Community Dwelling ◽  
Controlled Trials ◽  
Potentially Inappropriate Medications ◽  
Potentially Inappropriate Prescribing ◽  
Randomised Controlled ◽  
Community Dwelling Older Adults

Objective: To evaluate studies of pharmacist-led interventions on potentially inappropriate prescribing among community-dwelling older adults receiving primary care to identify the components of a successful intervention. Data sources: An electronic search of the literature was conducted using the following databases from inception to December 2015: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, MEDLINE (through Ovid), Trip, Centre for Reviews and Dissemination databases, Cochrane Database of Systematic Reviews, ISI Web of Science, ScienceDirect, ClinicalTrials.gov , metaRegister of Controlled Trials, ProQuest Dissertations & Theses Database (Theses in Great Britain, Ireland and North America). Review methods: Studies were included if they were randomised controlled trials or quasi-randomised studies involving a pharmacist-led intervention compared to usual/routine care which aimed to reduce potentially inappropriate prescribing in older adults in primary care. Methodological quality of the included studies was independently assessed. Results: A comprehensive literature search was conducted which identified 2193 studies following removal of duplicates. Five studies met the inclusion criteria. Four studies involved a pharmacist conducting a medication review and providing feedback to patients or their family physician. One randomised controlled trial evaluated the effect of a computerised tool that alerted pharmacists when elderly patients were newly prescribed potentially inappropriate medications. Four studies were associated with an improvement in prescribing appropriateness. Conclusion: Overall, this review demonstrates that pharmacist-led interventions may improve prescribing appropriateness in community-dwelling older adults. However, the quality of evidence is low. The role of a pharmacist working as part of a multidisciplinary primary care team requires further investigation to optimise prescribing in this group of patients.

scholarly journals Perioperative Magnesium for Postoperative Analgesia: An Umbrella Review of Systematic Reviews and Updated Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 11 (12) ◽  
pp. 1273
Author(s):  
Geun Joo Choi ◽  
Young Il Kim ◽  
Young Hyun Koo ◽  
Hyoung-Chul Oh ◽  
Hyun Kang
Keyword(s):  
Postoperative Pain ◽  
Beneficial Effect ◽  
Systematic Reviews ◽  
Postoperative Analgesia ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Umbrella Review ◽  
Randomized Controlled ◽  
Meta Analyses

The purpose of this study was to summarize and evaluate evidence on the effectiveness of perioperative magnesium as an adjuvant for postoperative analgesia. We conducted an umbrella review of the evidence across systematic reviews and meta-analyses of randomized controlled trials (RCTs) on the effect of perioperative magnesium on pain after surgical procedures. Two independent investigators retrieved pain-related outcomes and assessed the methodological quality of the evidence of included studies using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) tool, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. In addition, an updated meta-analysis of postoperative pain-related outcomes with a trial sequential analysis (TSA) was conducted. Of the 773 articles initially identified, 17 systematic reviews and meta-analyses of 258 RCTs were included in the current umbrella review. Based on the AMSTAR tool, the overall confidence of the included systematic reviews was deemed critically low to low. Pain score, analgesic consumption, time to first analgesic request, and incidence of analgesic request were examined as pain-related outcomes. According to the GRADE system, the overall quality of evidence ranged from very low to moderate. While the updated meta-analysis showed the beneficial effect of perioperative magnesium on postoperative analgesia, and TSA appeared to suggest sufficient existing evidence, the heterogeneity was substantial for every outcome. Although the majority of included systematic reviews and updated meta-analysis showed a significant improvement in outcomes related to pain after surgery when magnesium was administered during the perioperative period, the evidence reveals a limited confidence in the beneficial effect of perioperative magnesium on postoperative pain.

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