A systematic review of accidental injury from fire, wandering and medication self-administration errors for older adults with and without dementia

The assessment of risk of injury in the home is important for older adults when considering whether they are able to live independently. The purpose of this systematic review is to determine the frequency of injury for persons with dementia and the general older adult population, from three sources: fires/burns, medication self-administration errors and wandering. Relevant articles (n = 74) were screened and 16 studies were retained for independent review. The studies, although subject to selection and information bias, showed low proportions of morbidity and mortality from the three sources of injury. Data did not allow direct comparison of morbidity and mortality for persons with dementia and the general older adult population; however, data trends suggested greater event frequencies with medication self-administration and wandering for persons with dementia. Assessment targeting these sources of injury should have less emphasis in the general older adult population compared to persons with dementia.     

Cognitive frailty as a predictor of dementia among older adults: A systematic review and meta-analysis

ObjectiveThe aim of this systematic review and meta-analysis was to synthesize the pooled risk effect and to determine whether cognitive frailty is a predictor of dementia among older adults.DesignSystematic review and meta-analysis.Setting and participantsPubMed, EMBASE, Web of Science, and the Cochrane Library were systematically searched until June 5, 2019. Only cohort studies and population-based longitudinal studies published in English were eligible. Study selection, data extraction and quality assessment of including studies were independently completed by two researchers. A fixed-effects model was used to synthesize the risk of baseline cognitive frailty on dementia in the older adults compared with older adults without cognitive frailty.MeasurementsThe risk of cognitive frailty on incident dementia.ResultsOf the 1566 identified records, 7 studies met the inclusion criteria and were included in the review. And 4 studies reporting hazard ratio (HR) of incident dementia for cognitive frailty were included in the meta-analysis. Synthesized results showed that baseline cognitive frailty in the elderly was significantly associated with an increased risk of developing dementia as compared with those without cognitive frailty (prefrailty + CI model: pooled HR = 3.99, 95 %CI = 2.94–5.43, p < 0.00001, I² = 31 %; frailty + CI model: pooled HR = 5.58, 95 %CI = 3.17–9.85, p < 0.00001, I² = 0 %). Heterogeneity across the studies was low.ConclusionCognitive frailty is a significant predictor of dementia. Cognitive frailty status may be a novel modifiable target in identification of early signs before dementia.     

A systematic review of hypertension outcomes and treatment strategies in older adults

ObjectiveTo evaluate the literature regarding blood pressure control and management in older adult patient population over 70 years of age.MethodsA literature search was conducted using PubMed and capturing the data from 2006 to 2016. Terms used included MeSH headings for hypertension/therapy and antihypertension agents. A systematic review of published studies was performed. Articles including older patients (average age 70 years or older) being treated for hypertension were included. We analyzed the blood pressure goals and treatment regimens along with cardiovascular outcomes.ResultsSix trials were evaluated that met criteria for inclusion. A range of countries were represented including Europe, China, Australia, Tunisia, US, and Japan. The population size in the trials ranged from 142 to 4736. All studies included had adequate power to assess treatment effects. Blood pressure goals were variable and ranged from a systolic of <120 to <160 with a diastolic goal of <80 mmHg. Some studies reported outcomes including all-cause mortality, composite cardiovascular events, cardiovascular mortality, fatal and non-fatal stroke or myocardial infarction, and fatal or nonfatal heart failure. Many trials were stopped early because of the significant findings in mortality and cardiovascular outcomes.ConclusionsThe studies discussed had a range of blood pressure goals. The optimal management of hypertension in older adults is still being debated. Data from the clinical trials show that treating blood pressure to tight goals of at least <140/80, or lower if tolerated, confers benefit in cardiovascular outcomes.     

Efficacy of group psychotherapy for geriatric depression: A systematic review

BackgroundGeriatric depression is a common and debilitating psychopathology, but evidence supports the efficacy of psychotherapy in its treatment. Group therapy provides advantages over individual interventions. However, only three systematic reviews have focused specifically on the efficacy of group therapy for geriatric depression.ObjectiveTo ascertain the effects of group psychotherapy on geriatric depression in people aged 60 years and older, compared with alternative treatments or no treatment.Data sourcesA systematic review of English, Portuguese, and Spanish studies using the EBSCOhost Research and Science Direct databases (2011–2017). Additional studies were identified through reference lists. Search terms included group therapy, group psychotherapy, older adults, elderly, depressive disorder, geriatric depression, and depression in the elderly.Review methodsThe researcher screened any study designs concerning the effects of any paradigm of group therapy on geriatric depression versus alternative interventions or no treatment. Relevant data, including indicators of risk of bias, were extracted.Data synthesisNine studies were reviewed. Reminiscence therapy and cognitive-behavioral therapy are viable group interventions for geriatric depression, and were significantly superior to most controls. Conclusions about the long-term effects were unclear. Significant improvements were obtained for different intervention durations and facilitators, and with participants of different nationalities and age. Most studies recruited participants from the community, which limited generalizability. Group therapy also resulted in improvements in other psychological variables.ConclusionsGroup therapy can significantly improve geriatric depression. Improvements were found across a variety of settings, protocols, participant characteristics, and for several psychological domains.     

Non-pharmacological depression therapies for older Chinese adults: A systematic review & meta-analysis

PurposeTo conduct a systematic review of randomized controlled trials to evaluate the evidence for the use of non-pharmacological depression therapies in older Chinese adults.Materials and methodsThe population was individuals of Chinese extraction over the age of 60 who meet the criteria for depression. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Six healthcare databases were systematically searched for publications to the end date July 2018. Included study variables were extracted and methodological quality assessments were performed. Ten studies reported sufficient data for meta-analysis.ResultsFifteen experimental and quasi-experimental studies fulfilled the selection criteria (N = 904 participants). Twelve studies provided sufficient data to evaluate the therapies using Effect Size (ES) (Cohen’sd); ranged from low to high. In the Qigong studies ES varied d = 0.31–0.81, Reminiscence d = 0.20–2.37, and for single studies of Tai Chi d = 1.7 and for Life Story d = 1.46. From the meta-analyses, Qigong was the only treatment that had a significant effect on the severity of depression (Z = −4.47, p < 0.01) with acceptable statistical heterogeneity between studies (I² = 52 %).ConclusionOverall, there was a large methodological heterogeneity between studies attributed to differing treatments, duration and designs. Reminiscence and Life Story showed an overall effect from a range of measures, as did the exercise therapies Qigong and Tai Chi. Qigong was the only therapy having a significant effect on depression. This therapy may be useful to alleviate depression due to the group and social interaction.     

The effectiveness of a wearable activity tracker (WAT)-based intervention to improve physical activity levels in sedentary older adults: A systematic review and meta-analysis

BackgroundThe evidence shows that WAT-based interventions enhance the physical activity (PA) levels of young people by sustainably delivering behavior change techniques (BCTs). These results may not be replicable among older adults. This paper aims to evaluate the effectiveness of WAT-based interventions in improving PA levels in sedentary older adults.MethodsEight electronic databases were searched for randomized controlled trials published January 2008 to December 2018. BCTs delivered by WAT aimed at increasing PA levels using step counts or time spent on moderate-to-vigorous (MVPA) exercise as an outcome were eligible for inclusion.ResultsIn nine out of the ten included studies, higher PA levels were seen in the intervention group than in the control group. One study where the participants’ mean age was 80+ showed no significant increase in PA levels. Significant effects were also demonstrated from the meta-analysis, which included four studies using a passive control (i.e., the usual care or health information) on step counts (n = 207, Hedges g = 1.27, 95 % CI = 0.51–2.04, p = 0.001) and two studies on MVPA (n = 83, Hedge’s g = 1.23, 95 % CI = 0.75–1.70, p < 0.001). A non-significant effect was found on step counts (n = 201, Hedge’s g = 0.22, 95 % CI = −0.62 to 1.06, p = 0.61) in three studies that used an active control comparison group (i.e., traditional pedometer).ConclusionsA WAT-based intervention is effective at improving PA levels among older adults over the short term when compared with the usual care or health information. However, when compared with a traditional pedometer or when used among old-old adults, the results were inconclusive.     

Prevalence of falls among older adults in the Gulf Cooperation Council countries: A systematic review and meta-analysis

AimThe aim of this study was to conduct a systematic review and meta-analysis for studies that have examined the prevalence and risk factors of falls in older adults living in the Gulf Cooperation Council countries (GCC).MethodsA literature search was performed using PubMed, Web of Science, Physiotherapy Evidence Database; and SCOPUS up to October 2018 to identify studies that have examined prevalence, risk factors, or consequences of falls in older adults living in the GCC.ResultsA total of 6 studies met the inclusion criteria. The pooled prevalence of falls among older adults residing in GCC countries was 46.9%. Falls among included studies were associated with older age, female gender, low educational level, and number of medications.ConclusionsThe study shows a high prevalence of falls in older adults living in the GCC countries. The risk factors in the current study must be interpreted with caution, since some of the included studies did not report any risk factors. Due to the limited number of evidence evaluating risk factors and consequences of falls in the GCC countries population, a further longitudinal research is needed.     

Is training for informal caregivers and their older persons helpful? A systematic review

BackgroundThe steady increase in the number of people suffering from chronic diseases and increasing life expectancy raises new demands on health care. At the same time, the need for informal caregivers is increasing. This study aims to perform a systematic review of the methodologies used to identify effect of different types of training on informal caregivers and their older persons.MethodsMEDLINE (PubMed), CINAHL and Ovid were searched from December 2016 and April 2017. The following keywords were used; "informal caregiver", "training" "elderly", older persons". Identified publications were screened by using the following inclusion criteria; systematic reviews, randomized controlled trials, prospective cohort and multicentre studies, English language full text journals, samples or interventions that included caregivers of older persons and published in last 10 years.ResultsTwenty four studies (12 randomised control trials, 8 intervention studies and 4 systematic reviews) were included. Most of the randomized controlled trials involved both caregivers and elderly. Pretests and post-tests were used in intervention studies (5 out of the 8 studies). ICT-based, psychosocial interventions on family caregivers' education program for caregivers were applied. Caregivers following a supportive educative learning had a significantly better quality of life.ConclusionsThe findings of this systematic review suggest that support interventions for caregivers can be effective in reducing caregivers' stress, with a consequent improvement of the quality of care. However, results are based on relatively small studies, reporting somewhat controversial findings supporting the need to perform further research in this field.     

Muscle weakness and falls in older adults: a systematic review and meta-analysis

OBJECTIVES: To evaluate and summarize the evidence of muscle weakness as a risk factor for falls in older adults. DESIGN: Random-effects meta-analysis. SETTING: English-language studies indexed in MEDLINE and CINAHL (1985-2002) under the key words aged and accidental falls and risk factors; bibliographies of retrieved papers. PARTICIPANTS: Fifty percent or more subjects in a study were aged 65 and older. Studies of institutionalized and community-dwelling subjects were included. MEASUREMENTS: Prospective cohort studies that included measurement of muscle strength at inception (in isolation or with other factors) with follow-up for occurrence of falls. METHODS: Sample size, population, setting, measure of muscle strength, and length of follow-up, raw data if no risk estimate, odds ratios (ORs), rate ratios, or incidence density ratios. Each study was assessed using the validity criteria: adjustment for confounders, objective definition of fall outcome, reliable method of measuring muscle strength, and blinded outcome measurement. RESULTS: Thirty studies met the selection criteria; data were available from 13. For lower extremity weakness, the combined OR was 1.76 (95% confidence interval (CI)=1.31-2.37) for any fall and 3.06 (95% CI=1.86-5.04) for recurrent falls. For upper extremity weakness the combined OR was 1.53 (95% CI=1.01-2.32) for any fall and 1.41 (95% CI=1.25-1.59) for recurrent falls. CONCLUSION: Muscle strength (especially lower extremity) should be one of the factors that is assessed and treated in older adults at risk for falls. More clinical trials are needed to isolate whether muscle-strengthening exercises are effective in preventing falls.     

Adverse events and treatment discontinuations of antimuscarinics for the treatment of overactive bladder in older adults: A systematic review and meta-analysis

IntroductionAntimuscarinics should be used with caution in older adults with overactive bladder (OAB) due to anticholinergic adverse events (AEs). Systematic reviews and meta-analyses (SRMAs) have analyzed safety-related outcomes but have not specified risk in the elderly, the population at highest risk for AEs. The aim of this review is to explore and evaluate AEs and treatment discontinuations in adults 65 or older taking antimuscarinics for OAB.MethodsKeywords were searched in MEDLINE, EMBASE, SCOPUS, and Cochrane Central Register for Controlled Trials. Randomized controlled trials (RCTs) along with sub-analyses and pooled analyses that compared antimuscarinics to placebo or another antimuscarinic were performed in February 2015. Studies assessing AEs or treatment discontinuations in a population of adults 65 or older were included. The Jadad Criteria and McHarm Tool were used to assess the quality of the trials.ResultsA total of 16 studies met the inclusion criteria. Eighty AEs and 27 reasons for treatment discontinuation were described in the included studies and further explored. Anticholinergic AEs were more common in antimuscarinics compared to placebo. Incidence of dizziness, dyspepsia, and urinary retention with fesoterodine, headache with darifenacin, and urinary tract infections with solifenacin were significantly higher compared to placebo. Treatment discontinuation due to AEs and dry mouth were higher in the antimuscarinics when compared to placebo in older adults.ConclusionsTreatment for overactive bladder using antimuscarinics in adults aged 65 or older resulted in significant increases in risk for several AEs compared to placebo including anticholinergic and non-anticholinergic AEs.     

Game-based brain training for improving cognitive function in community-dwelling older adults: A systematic review and meta-regression

BackgroundGiven that increasing aging is associated with a natural decline in cognitive function, identifying effective interventions that can help to prevent cognitive decline in older adults is a research priority.ObjectiveTo synthesize the best evidence to assess the effectiveness of game-based brain training in improving cognitive function and to evaluate the preferred design features of the intervention.MethodsTwelve databases, trial registries, and gray literature resources were systematically searched for in randomized controlled trials. Meta-analysis and random-effects meta-regression were conducted using Comprehensive Meta-analysis Software 3.0. Overall effect was measured using Hedges’s g and determined using Z-statistics. Cochran’s Q test and I² were used to investigate heterogeneity. The Grading of Recommendation, Assessment, Development, and Evaluation system was used to assess overall quality of evidence.ResultsFifteen trials among 759 older adults were conducted. Meta-analysis revealed that game-based brain training significantly improved processing speed (g = 0.23), selective attention (g = 0.40), and short-term memory (g = 0.35) versus a control group. Our subgroup analyses emphasized that non-time pressure games, multiplayer, computer platform, provider support, sessions ≤ 3 times per week for ≤ 60 min. each comprised a preferable design. Meta-regression identified game design (β = 0.211, p = 0.008) that had statistically significant effects on processing speed. Egger’s regression asymmetry test (p = 0.293) suggested no publication bias.ConclusionsGame-based brain training can be considered a supplementary intervention for improving cognitive functions in community-dwelling older adults. Future trials should use well-designed trials with large sample sizes.     

The experiences and needs of Asian older adults who are socially isolated and lonely: A qualitative systematic review

PurposeTo examine the experiences and needs of Asian older adults who are socially isolated and lonely living in Asian and western countries.Materials and methodsSix databases were searched for qualitative studies from each database’s inception to December 2019. Qualitative data were meta-summarized and then meta-synthesized.ResultsFourteen studies were included in this review. Five themes emerged: (1) association with older adults’ well-being, (2) loss of social support, (3) dealing with social isolation and loneliness (4) unique experiences of Asian older adults in western countries, and (5) wish list of older adults. The older adults felt psychologically down and experienced a lack of social support from their family members. They coped using strategies such as religious reliance and social engagement with peers. Asian older adults in western countries faced cultural barriers and tried to form ethnic communities. The older adults wished for more community resources and care.ConclusionThere were multiple associations of social isolation and loneliness on the Asian older adults’ well-being and social support. Coping mechanisms such as acceptance and social engagement were adopted. They expressed support needs such as social programs and healthcare services. More geographically distributed studies are needed to gather a more comprehensive and causality-related perspectives of socially isolated and lonely older adults. Lay-led programs, technology, and active coping strategies are proposed and can be incorporated in healthcare services and social programs to assist these older adults.     

Outcomes related to nutrition screening in community living older adults: A systematic literature review

IntroductionNutrition screening is an initial procedure in which the risk of malnutrition is identified. The aims of this review were to identify malnutrition risk from nutrition screening studies that have used validated nutrition screening tools in community living older adults; and to identify types of nutrition interventions, pathways of care and patient outcomes following screening.MethodsA systematic literature search was performed for the period from January 1994 until December 2013 using SCOPUS, CINAHL Plus with Full Text, PubMed and COCHRANE databases as well as a manual search. Inclusion and exclusion criteria were determined for the literature searches and the methodology followed the PRISMA guidelines.ResultsFifty-four articles were eligible to be included in the review and malnutrition risk varied from 0% to 83%. This large range was influenced by the different tools used and heterogeneity of study samples. Most of the studies were cross sectional and without a subsequent nutrition intervention component. Types of nutrition intervention that were identified included dietetics care, nutrition education, and referral to Meals on Wheels services and community services. These interventions helped to improve the’ nutritional status of older adults.ConclusionsTimely nutrition screening of older adults living in the community, if followed up with appropriate intervention and monitoring improves the nutritional status of older adults. This indicates that nutrition intervention should be considered a priority following nutrition screening for malnourished and at risk older adults. Further evaluation of outcomes of nutrition screening and associated interventions, using structured pathways of care, is warranted.     

Self-care in Iranian patients with diabetes: A systematic review and meta-analysis

ObjectivesSelf-care is a major factor in managing diabetes. This study aimed to determine the self-care status of Iranian patients with diabetes and to estimate the percentage of self-care in these individuals through a systematic review and meta-analysis.MethodsIn this systematic review and meta-analysis 53 domestic articles published in Farsi and English were evaluated. We conducted database searches in domestic and foreign databases of Scientific Information Database (SID), MagIran, Google Scholar, Web of Science, Pub Med, and Scopus with no time limit. Data analysis was performed in Stata version 12 using meta-analysis method and the random effects model.ResultsA total of 50 articles (53 groups) with a sample size of 9565 were systematically reviewed. The percentage of self-care in patients with diabetes was reported to be 48.86 (95% confidence interval [CI]: 43.79–53.94). According to the results, the percentage of self-care score was higher in patients with type I diabetes (55.53) when compared with patients with type II diabetes (49.26).ConclusionsSince patients with diabetes obtained only half of the self-care score and given the importance of self-care in controlling and treating diabetes, it is necessary to perform actions to improve self-care such as benefiting from health facilities, and social and family support.     

Questionnaire measures of self-directed ageing stereotype in older adults: a systematic review of measurement properties

The population is ageing, but while average life expectancy continues to increase, healthy life expectancy has not necessarily matched this and negative ageing stereotypes remain prevalent. Self-directed ageing stereotypes are hypothesised to play an important role in older adults’ health and well-being; however, a wide variety of terms and measures are used to explore this construct meaning there is a lack of clarity within the literature. A review was conducted to identify tools used to measure self-directed ageing stereotype in older adults and evaluate their quality. Searches identified 109 papers incorporating 40 different measures. Most common were the Philadelphia Geriatric Centre Morale Scale Attitude Towards Own Ageing (ATOA) subscale, Ageing Perceptions Questionnaire (APQ) and Attitudes to Ageing Questionnaire. Despite being most frequently used, the ATOA was developed to measure morale in older adults rather than self-directed ageing stereotypes. Over 25 terms were used to describe the concept, and it is suggested that for consistency the term “self-directed ageing stereotype” be adopted universally. Across measures, poor reporting of psychometric properties made it difficult to assess scale quality and more research is needed to fully assess measures before conclusions can be drawn as to the best tool; however, the Brief-APQ appears to hold most promise. Future research must address this issue before interventions to reduce negative self-directed ageing stereotypes can be developed and fully evaluated.Electronic supplementary materialThe online version of this article (10.1007/s10433-020-00574-7) contains supplementary material, which is available to authorized users.