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Results for 'systematic reviews'

Results 1 - 10 of 27

Economic evaluations of falls prevention programs for older adults: a systematic review

OLIJ Branko F., et al
2018

Objectives: To provide a comprehensive overview of economic evaluations of falls prevention programs and to evaluate the methodology and quality of these studies. Design: Systematic review of economic evaluations on falls prevention programs. Setting: Studies (N=31) of community‐dwelling older adults (n=25), of older adults living in residential care facilities (n=3), and of both populations (n=3) published before May 2017. Participants: Adults aged 60 and older. Measurements: Information on study characteristics and health economics was collected. Study quality was appraised using the 20‐item Consensus on Health Economic Criteria. Results: Economic evaluations of falls prevention through exercise (n = 9), home assessment (n = 6), medication adjustment (n = 4), multifactorial programs (n = 11), and various other programs (n = 13) were identified. Approximately two‐thirds of all reported incremental cost‐effectiveness ratios (ICERs) with quality‐adjusted life‐years (QALYs) as outcome were below the willingness‐to‐pay threshold of $50,000 per QALY. All studies on home assessment and medication adjustment programs reported favorable ICERs, whereas the results of studies on exercise and multifactorial programs were inconsistent. The overall methodological quality of the studies was good, although there was variation between studies. Conclusion: The majority of the reported ICERs indicated that falls prevention programs were cost‐effective, but methodological differences between studies hampered direct comparison of the cost‐effectiveness of program types. The results imply that investing in falls prevention programs for adults aged 60 and older is cost‐effective. Home assessment programs (ICERs < $40,000/QALY) were the most cost‐effective type of program for community‐dwelling older adults, and medication adjustment programs (ICERs < $13,000/QALY) were the most cost‐effective type of program for older adults living in a residential care facility.

Occupational therapy fall prevention interventions for community-dwelling older adults: a systematic review

ELLIOTT Sharon, LELAND Natalie E.
2018

OBJECTIVE: Accidental falls among community-dwelling older adults are preventable and increase the risk of morbidity, hospitalization, and institutionalization. We updated and broadened a 2008 systematic review examining the evidence for the effectiveness of fall prevention interventions in improving fall-related outcomes, occupational performance, quality of life, and health care facility readmissions for community-dwelling older adults., METHOD: Literature published from 2008 to 2015 from five electronic databases was searched and analysed, RESULTS: Fifty articles met the inclusion criteria and were critically appraised and synthesized-37 provided Level I; 5, Level II; and 8, Level III evidence. Analysis was organized into four intervention themes: single component, multicomponent, multifactorial, and population based. Mixed evidence was found for single-component and multifactorial interventions, strong evidence was found for multicomponent interventions, and moderate evidence was found for population-based interventions., CONCLUSION: These findings can inform the delivery and integration of fall prevention interventions from acute care to community discharge.Copyright © 2018 by the American Occupational Therapy Association, Inc.

Tackling loneliness: briefing

WHAT WORKS CENTRE FOR WELLBEING
2018

Based on a systematic review of evidence reviews, this briefing summarises the evidence on what works in alleviating loneliness in people aged 55 years and older. A total of 364 reviews were identified and 28 were included in the final review. The review found there is a need for greater clarity on the concept of loneliness and how it differs from social isolation, for both researchers and practitioners. Other key findings show that there is no one-size fits-all approach to alleviating loneliness in older population groups and that tailored approaches are more likely to reduce loneliness. A number of different approaches are being used to alleviate loneliness in older adults. These include: leisure activities; therapies; social and community interventions; educational approaches; befriending; and system-wide activities, such as changing the cultures of care. There was no evidence of approaches doing any harm, however there was a suggestion that some technology-based approaches are not suitable for everyone and could reinforce a sense of social isolation. Suggestions are made on how to improve the evidence-based on interventions for loneliness. The briefing also provides a case study of Community Webs, a project to reduce loneliness and social isolation of patients presenting to GP practices by mobilising community assets.

An overview of reviews: the effectiveness of interventions to address loneliness at all stages of the life-course

VICTOR Christina, et al
2018

This systematic review of reviews examines the effectiveness of interventions to alleviate loneliness. Searches retrieved 364 evidence reviews for screening. The final review provides a synthesis of 14 reviews and 14 reports identified from the grey literature, focused on assessing interventions to alleviate loneliness. The material included is International and from within the UK. All published and grey literature studies included focus on older people. Key findings show that there is no one-size fits-all approach to alleviating loneliness in older population groups and that tailored approaches are more likely to reduce loneliness. A number of different approaches are being used to alleviate loneliness in older adults. These include: leisure activities; therapies; social and community interventions; educational approaches; befriending; and system-wide activities, such as changing the cultures of care. There was no evidence of approaches doing any harm, however there was a suggestion that some technology-based approaches are not suitable for everyone and could reinforce a sense of social isolation. A wide variety of loneliness measures were used, and the concept of loneliness was not clearly defined, with the terms loneliness and social isolation often used interchangeably. The results from controlled study designs in community settings and care homes showed no effect of interventions on loneliness. However, the review notes that loneliness is seldom reported as a primary outcome in the published literature. The review makes a number of recommendations for policy.

Strategies employed by older people to manage loneliness: systematic review of qualitative studies and model development

KHARICHA Kalpa, et al
2018

Objectives: To (i) systematically identify and review strategies employed by community dwelling lonely older people to manage their loneliness and (ii) develop a model for managing loneliness. Methods: A narrative synthesis review of English-language qualitative evidence, following Economic and Social Research Council guidance. Seven electronic databases were searched (1990–January 2017). The narrative synthesis included tabulation, thematic analysis, and conceptual model development. All co-authors assessed eligibility of final papers and reached a consensus on analytic themes. Results: From 3,043 records, 11 studies were eligible including a total of 502 older people. Strategies employed to manage loneliness can be described by a model with two overarching dimensions, one related to the context of coping (alone or with/in reference to others), the other related to strategy type (prevention/action or acceptance/endurance of loneliness). The dynamic and subjective nature of loneliness is reflected in the variety of coping mechanisms, drawing on individual coping styles and highlighting considerable efforts in managing time, contacting others, and keeping loneliness hidden. Cognitive strategies were used to re-frame negative feelings, to make them more manageable or to shift the focus from the present or themselves. Few unsuccessful strategies were described. Conclusion: Strategies to manage loneliness vary from prevention/action through to acceptance and endurance. There are distinct preferences to cope alone or involve others; only those in the latter category are likely to engage with services and social activities. Older people who deal with their loneliness privately may find it difficult to articulate an inability to cope.

A systematic review of outdoor recreation (in green space and blue space) for families to promote subjective wellbeing

MANSFIELD Lousie, et al
2018

This systematic review looks at the wellbeing outcomes when taking part in outdoor activities with family. Although there is existing evidence on the benefits being outdoors has for our wellbeing, there is less evidence of the wellbeing benefits when the time is spent with family. The review included empirical research assessing the relationship between outdoor recreation interventions for families and subjective wellbeing, published from 1997 - October 2017 and grey literature published from 2007-2017. The review reports on fifteen studies in total, including two quantitative, one mixed methods (RCT and interviews), and ten qualitative studies. Overall the review found the evidence base was limited with the number of studies and quality, especially for quantitative studies. The evidence from quantitative studies indicates that taking part in outdoor recreation with families has no significant effect on children's quality of life, and has no significant effect on self-esteem and other measures of psychological wellbeing. Initial evidence findings from qualitative studies showed more positive impacts when taking part in outdoor recreation with families, showing improved self-competence learning and identity; improved wellbeing via escapism, relaxation and sensory experience; and improved social bonding as a family. Analysis of survey data found that people's enjoyment of the outdoors is enhanced when they are spending time with family and friends, and in particular with partners.

Yoga-based exercise improves health-related quality of life and mental well-being in older people: a systematic review of randomised controlled trials

TULLOCH Alice, et al
2018

Objective: health-related quality of life (HRQOL) and mental well-being are associated with healthy ageing. Physical activity positively impacts both HRQOL and mental well-being. Yoga is a physical activity that can be modified to suits the needs of older people and is growing in popularity. A systematic review was conducted with meta-analysis to determine the impact of yoga-based exercise on HRQOL and mental well-being in people aged 60+. Methods: searches were conducted for relevant trials in the following electronic databases; MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Allied and Complementary Medicine Database, PsycINFO and the Physiotherapy Evidence Database (PEDro) from inception to January 2017. Trials that evaluated the effect of physical yoga on HRQOL and/or on mental well-being in people aged 60+ years were included. Data on HRQOL and mental well-being were extracted. Standardised mean differences and 95% confidence intervals (CI) were calculated using random effects models. Methodological quality of trials was assessed using the PEDro scale. Results: twelve trials of high methodological quality (mean PEDro score 6.1), totalling 752 participants, were identified and provided data for the meta-analysis. Yoga produced a medium effect on HRQOL (Hedges’ g = 0.51, 95% CI 0.25–0.76, 12 trials) and a small effect on mental well-being (Hedges’ g = 0.38, 95% CI 0.15–0.62, 12 trials). Conclusion: yoga interventions resulted in small to moderate improvements in both HRQOL and mental well-being in people aged 60+ years. Further, research is needed to determine the optimal dose of yoga to maximise health impact.

Cognitive behavioural therapy for fear of falling and balance among older people: a systematic review and meta-analysis

LIU Tai-Wa, et al
2018

Background: fear of falling is prevalent among older people and associated with various health outcomes. A growing number of studies have examined the effects of interventions designed to reduce the fear of falling and improve balance among older people, yet our current understanding is restricted to physiological interventions. Psychological interventions such as cognitive behavioural therapy (CBT) have not been reviewed and meta-analysed. Objective: to perform a systematic review and meta-analysis evaluating the effects of CBT on reducing fear of falling and enhancing balance in community-dwelling older people. Method: randomised controlled trials (RCTs) addressing fear of falling and balance were identified through searches of six electronic databases, concurrent registered clinical trials, forward citation and reference lists of three previous systematic reviews. Results: a total of six trials involving 1,626 participants were identified. Four studies used group-based interventions and two adopted individual intervention. Intervention period ranged from 4 to 20 weeks, and the number and duration of face-to-face contact varied. Core components of the CBT intervention included cognitive restructuring, personal goal setting and promotion of physical activities. The risk of bias was low across the included studies. Our analysis suggests that CBT interventions have significant immediate and retention effects up to 12 months on reducing fear of falling, and 6 months post-intervention effect on enhancing balance. Conclusions: CBT appears to be effective in reducing fear of falling and improving balance among older people. Future researches to investigate the use of CBT on reducing fear of falling and improving balance are warranted.

Reducing falls in older adults recently discharged from hospital: a systematic review and meta-analysis

NASERI Chiara, et al
2018

Background: older adults are known to have increased falls rates and functional decline following hospital discharge, with substantial economic healthcare costs. This systematic review aimed to synthesise the evidence for effective falls prevention interventions in older adults recently discharged from hospital. Methods: literature searches of six databases of quantitative studies conducted from 1990 to June 2017, reporting falls outcomes of falls prevention interventions for community-dwelling older adults discharged from hospital were included. Study quality was assessed using a standardised JBI critical appraisal tool (MAStARI) and data pooled using Rev-Man Review Manager® Results: sixteen studies (total sample size N = 3,290, from eight countries, mean age 77) comprising 12 interventions met inclusion criteria. Findings: home hazard modification interventions delivered to those with a previous falls history (1 study), was effective in reducing the number of falls (RR 0.63, 95%CI 0.43, 0.93, Low GRADE evidence). Home exercise interventions (3 studies) significantly increased the proportion of fallers (OR 1.74, 95%CI 1.17, 2.60, Moderate GRADE evidence), and did not significantly reduce falls rate (RR 1.27, 95%CI 0.99, 1.62, Very Low GRADE evidence) or falls injury rate (RR 1.16, 95%CI, 0.83,1.63, Low GRADE evidence). Nutritional supplementation for malnourished older adults (1 study) significantly reduced the proportion of fallers (HR 0.41, 95% CI 0.19, 0.86, Low GRADE evidence). Conclusion: the recommended falls prevention interventions for older adults recently discharged from hospital are to provide home hazard minimisation particularly if they have a recent previous falls history and consider nutritional supplementation if they are malnourished.

What is the impact on health and wellbeing of interventions that foster respect and social inclusion in community-residing older adults? A systematic review of quantitative and qualitative studies

RONZI S., et al
2018

Background: Many interventions have been developed to promote respect and social inclusion among older people, but the evidence on their impacts on health has not been synthesised. This systematic review aims to appraise the state of the evidence across the quantitative and qualitative literature. Methods: Eligible studies published between 1990 and 2015 were identified by scanning seven bibliographic databases using a pre-piloted strategy, searching grey literature and contacting experts. Studies were included if they assessed the impact (quantitatively) and/or perceived impact (qualitatively) of an intervention promoting respect and social inclusion on the physical or mental health of community-residing people aged 60 years and older. Titles and abstracts were screened for eligibility by one reviewer. A second reviewer independently screened a 10% random sample. Full texts were screened for eligibility by one reviewer, with verification by another reviewer. Risk of bias was assessed using standardised tools. Findings were summarised using narrative synthesis, harvest plots and logic models to depict the potential pathways to health outcomes. Results: Of the 27,354 records retrieved, 40 studies (23 quantitative, 6 qualitative, 11 mixed methods) were included. All studies were conducted in high and upper middle-income countries. Interventions involved mentoring, intergenerational and multi-activity programmes, dancing, music and singing, art and culture and information-communication technology. Most studies (n = 24) were at high or moderate risk of bias. Music and singing, intergenerational interventions, art and culture and multi-activity interventions were associated with an overall positive impact on health outcomes. This included depression (n = 3), wellbeing (n = 3), subjective health (n = 2), quality of life (n = 2), perceived stress and mental health (n = 2) and physical health (n = 2). Qualitative studies offered explanations for mediating factors (e.g. improved self-esteem) that may lead to improved health outcomes and contributed to the assessment of causation. Conclusions: Whilst this review suggests that some interventions may positively impact on the health outcomes of older people, and identified mediating factors to health outcomes, the evidence is based on studies with heterogeneous methodologies. Many of the interventions were delivered as projects to selected groups, raising important questions about the feasibility of wider implementation and the potential for population-wide benefits.

Results 1 - 10 of 27

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