Alcohol in older people: systematic reviews of interventions and context

BackgroundHarmful alcohol consumption is increasing in older people because of an ageing population and heavier consumption in the generation now reaching older age. This work was part of a comprehensive evidence synthesis of preventive health behaviour interventions to inform policy and identify evidence gaps relating to ageing well and cognitive health.MethodsThree systematic reviews in older populations were done to identify interventions to prevent or reduce excessive alcohol consumption, to identify the same type of interventions that also report cognitive and dementia outcomes, and to identify barriers and facilitators. Treatment for alcohol dependence was excluded. Multiple databases (Medline, Embase, PsycINFO, CINAHL, CENTRAL, Social Sciences Citation Index, and grey literature) were searched for studies published from 2000 in English, from Organisation for Economic Co-operation and Development countries. MeSH terms and text words relating to alcohol consumption and behaviour were used combined with older age terms (appendix). Risk of bias was assessed with National Institute for Health and Care Excellence methodology.Findings12 intervention studies targeting prevention or reduction of excessive alcohol consumption and 11 qualitative studies reporting barriers and facilitators were identified, but none with cognitive or dementia outcomes. Only three studies related to prevention; and nine aimed to reduce alcohol in harmful or hazardous drinkers in primary care. A complex range of intervention types, intensity, and delivery was found. Five studies that compared one type of intervention with another or compared more intensive interventions with minimal intervention found no differences, although both groups markedly reduced alcohol consumption. Limited evidence (three studies) suggested that more intensive interventions that include personalised feedback could have the greatest effects in older hazardous drinkers. However, some evidence suggested that simple interventions including brief interventions, leaflets, and alcohol assessments with advice to reduce drinking can also have a positive effect. From qualitative studies, drinking in some older people was strongly linked to social engagement and enjoyment of life and there was scepticism about the health risks of alcohol. Conversely, drinking was also linked to difficulties such as social isolation, stress, illness, or bereavement. Emphasis on the experience of older people to drink wisely in a positive controlled way could be a facilitator.InterpretationAlcohol interventions in older people can be effective. Messages might need to consider the impact on social engagement in light of potential benefits of social participation for cognitive health.FundingNational Institute for Health Research (NIHR) School for Public Health Research and NIHR Collaboration for Leadership in Applied Health Research East of England.     

Increased healthcare costs associated with frailty among community-dwelling older people: A systematic review and meta-analysis

BackgroundAlthough frailty of older people has been shown to be associated with numerous adverse health outcomes, evidence on healthcare costs associated with frailty is scarce.MethodsMedline, Embase, PsycINFO, and AMED were electronically searched in January 2019 based on a protocol in accordance with the PRISMA statement using Medical Subjective Heading and free text terms, with explosion functions. Language restriction was not applied. Studies were considered if they were published between 2000 to January 2019 and provided healthcare costs stratified by the frailty status categories among community-dwelling older people with a mean age of 60 years or higher. Reference lists of the included studies were reviewed for additional studies. Healthcare costs according to frailty status were compared using standardized mean difference random-effects meta-analysis.ResultsThe systematic review found 3116 citations. After screening for title, abstract, and full-text for eligibility, 5 studies involving 3742362 participants were included. Healthcare costs were compared across three frailty status, robust, prefrailty, and frailty. Both prefrailty (5 studies, Hedges’ g = 0.24, 95% confidence interval (CI) = 0.15-0.33, p < 0.001) and frailty (5 studies, Hedges’ g = 0.62, 95%CI = 0.61-0.62, p < 0.001) were associated with significantly higher healthcare costs when compared with robustness. There was a high degree of heterogeneity. The risk of publication bias was considered to be low in funnel plots.ConclusionsThis systematic review and meta-analysis found a dose-response increase in the healthcare costs associated with frailty among community-dwelling older adults. Future research should recognize frailty as an important factor associated with increased healthcare costs.     

Environmental interventions to prevent falls in community-dwelling older people: a meta-analysis of randomized trials

Objective. This study seeks to determine the efficacy of environmental interventions in reducing falls in community-dwelling older people. Method. A systematic review and meta-analysis of randomized trials was performed. Results. Pooled analysis of six trials (N = 3,298) demonstrated a 21% reduction in falls risk (relative risk [RR] = 0.79; 0.65 to 0.97). Heterogeneity was attributable to the large treatment effect of one trial. Analysis of a subgroup of studies with participants at high risk of falls (four trials, n = 570) demonstrated a clinically significant 39% reduction of falls (RR = 0.61; 0.47 to 0.79), an absolute risk difference of 26% for a number needed to treat four people. Discussion. Home assessment interventions that are comprehensive, are well focused, and incorporate an environmental-fit perspective with adequate follow-up can be successful in reducing falls with significant effects. The highest effects are associated with interventions that are conducted with high-risk groups.     

Dropout from physical activity interventions in people living with HIV: a systematic review and meta-analysis

Physical activity (PA) interventions have been shown to improve the health of people living with HIV (PLWH), yet treatment dropout poses an important challenge. We conducted a meta-analysis to investigate the prevalence and predictors of treatment dropout in PA interventions in PLWH. Electronic databases were searched for records up to September 2016. Randomized control trials of PA interventions in PLWH reporting dropout rates were included. Random effects meta-analysis and meta-regression analyses were employed. In 36 studies involving 49 PA intervention arms, 1128 PLWH were included (mean age?=?41.6 years; 79.3% male; 39% White). The trim and fill adjusted treatment dropout rate was 29.3% (95% CI?=?24.5–34.7%). There was a significant lower dropout rate in resistance training interventions compared with aerobic (p?=?0.003) PA interventions, in studies utilizing supervised interventions throughout the study period (p?p?β?=?1.15, standard error (SE)?=?0.49, z?=?2.0, p?=?0.048), a lower body mass index(BMI) (β?=?0.14, SE?=?0.06, z?=?2.16, p?=?0.03), and a lower cardiorespiratory fitness (β?=?0.10, SE?=?0.04, z?=?2.7, p?=?0.006). The dropout from PA interventions is much higher in PLWH than in many other populations with chronic morbidities. Qualified professionals (i.e., exercise physiologists, physical educators, or physical therapists) should be incorporated as key care providers in the multidisciplinary care of HIV/AIDS and should prescribe supervised PA for PLWH in order to enhance adherence and reduce the burden of HIV/AIDS. Special attention should be given men, those with a higher BMI, and those with a lower cardiorespiratory fitness.     

Non-pharmacological prevention of major depression among community-dwelling older adults: A systematic review of the efficacy of psychotherapy interventions

Depression is a major public health burden among the aging population. While older adults prefer non-pharmacological treatment, few options for psychotherapy are available in primary care settings, which is where older adults tend to receive mental health services. Indicated prevention is a cost-effective, public health approach to prevent major depressive disorder among people with depressive symptoms who do not yet meet standard criteria for major depression. We critically reviewed randomized controlled trials (RCTs) that assessed the efficacy of psychotherapy among community-dwelling older adults with subthreshold depression (depressive symptoms that do not meet standard criteria for major depression). We examined the intervention types, results, internal validity, and external validity of five studies. We used the United States Preventive Services Task Force (USPSTF) guidelines to rate the quality of the studies and to provide recommendations. Results suggest that psychotherapy is a safe and cost-effective method to reduce the public health burden of depression among older adults with subthreshold depression.     

Environmental correlates of physical activity and dietary behaviours among young people: a systematic review of reviews

An extensive body of research exists on environmental influences on weight‐related behaviours in young people. Existing reviews aimed to synthesize this body of work, but generally focused on specific samples, behaviours or environmental influences and integration of findings is lacking. Hereto, we reviewed 18 reviews representing 671 unique studies, aiming to identify what environmental factors do and do not affect physical activity and dietary behaviours in children and adolescents. Eleven reviews focused exclusively on physical activity, six on diet, and one review focused on both physical activity and dietary behaviours with only small overlap in included studies. Physical activity was more consistently related to school and neighbourhood characteristics than to interpersonal and societal environments. In contrast, interpersonal factors played a pronounced role in dietary behaviours; no school, neighbourhood or societal factors were consistently related to dietary behaviours. This review of reviews adds to the literature by providing a comprehensive synthesis of factors related to physical activity and dietary behaviours that could be targeted in interventions. Moreover, by identifying factors that are unrelated to physical activity and dietary behaviours, this review may help to narrow the scope of future studies and environmental interventions.     

Achieved systolic blood pressure in older people: a systematic review and meta-analysis

Background

It remains unclear into which level the systolic blood pressure (SBP) should be lowered in order to provide the best cardiovascular protection among older people. Hypertension guidelines recommendation on attaining SBP levels <150 mmHg in this population is currently based on experts’ opinion. To clarify this issue, we systematically reviewed and quantified available evidence on the impact of achieving different SBP levels <150 mmHg on various adverse outcomes in subjects aged ≥60 years old receiving antihypertensive drug treatment.

Methods

We searched 8 databases to identify randomized controlled trials (RCTs) and post-hoc analyses or subanalyses of RCTs reporting the effects of attaining different SBP levels <150 mmHg on the risk of stroke, acute myocardial infarction, heart failure, cardiovascular mortality and all-cause mortality in participants aged ≥60 years. We performed random-effects meta-analyses stratified by study design.

Results

Eleven studies (> 33,600 participants) were included. Compared with attaining SBP levels ≥140 mmHg, levels of 130 to <140 mmHg were not associated with lower risk of outcomes in the meta-analysis of RCTs, whereas there was an associated reduction of cardiovascular mortality (RR 0.72, 95% CI 0.59–0.88) and all-cause mortality (RR 0.86, 95% CI 0.75–0.99) in the meta-analysis of post-hoc analyses or subanalyses of RCTs. Limited and conflicting data were available for the SBP levels of <130 mmHg and 140 to <150 mmHg.

Conclusions

Among older people, there is suggestive evidence that achieving SBP levels of 130 to <140 mmHg is associated with lower risks of cardiovascular and all-cause mortality. Future trials are required to confirm these findings and to provide additional evidence regarding the <130 and 140 to <150 mmHg SBP levels.

     

Exercise interventions for older people at risk for frailty: A protocol for systematic review and meta-analysis

Background:Frailty is a state of age-related reduced physiological reserve characterized by an increased risk of adverse clinical outcomes. Studies have shown that exercise can improve frailty in older people. However, it remains to be seen which exercises will most improve the fitness of older people with frailty or those at the risk for frailty.Objective: This protocol aims to determine whether physical exercise can improve frailty in older people, and if which methods are most effective.Methods:We searched the following databases for relevant articles published between January 1, 2012 and January 1, 2021: PubMed, EMBASE, the Cochrane Library, Wanfang, the China National Knowledge Infrastructure, Clinical Trials Database, and the Science Network. Two independent reviewers will carry out data extraction, discuss and resolve differences, and obtain consensus from the third author. We will select randomized control trials (RCTs) according to the preformulated inclusion criteria. The main outcomes in this study are scores from Fried Frailty Phenotype Criteria; the Frailty Trait Scale–short form; the SHARE Frailty Instrument; the FRAIL scale; the Gérontopôle Frailty Screening Tool; the Clinical Frailty Scale, the Rockwood and Mitnitsky Frailty Index; the Study of Osteoporotic Fractures Index; the Edmonton Frailty Scale; the Fatigue, Resistance, Ambulation, Illness and Loss of Weight Index; the Multidimensional Prognostic Index; the Tilburg Frailty Indicator; PRISMA-7; the Groningen Frailty Indicator; the Sherbrooke Postal Questionnaire; and the Kihon Checklist. Secondary outcomes are muscle strength, gait velocity, stair-climbing power, and level of spontaneous physical activity. If the heterogeneity test shows slight or no statistical heterogeneity, a fixed effects model will be used for data synthesis; otherwise, a random effects model will be used. We will develop a unified data extraction table that includes a number of parameters. The Cochrane Cooperative Bias Risk Tool will be used to evaluate the methodological quality of the selected RCTs. RevMan Manager 5.3 and STATA 14.0 will be used for data analysis if enough RCTs (more than 10) are identified and selected.Result:The final results will provide information on the effectiveness of intervention programs for frail older adul and further demonstrate which exercise programs are more effective and which methods can significantly improve frailty.Conclusion:This protocol will contribute to the development of more effective interventions for elderly individuals with frailty.Ethics and dissemination:This study applies existing literature references; therefore, ethical approval is not required.INPLASY registration number:INPLASY202130107     

Physical activity and functional status in community-dwelling older women: a 14-year prospective study

BACKGROUND: Short-term prospective studies have shown physical activity to be related to functional status. To our knowledge, the association between physical activity levels and functional status over a longer period has not been established. METHODS: Two hundred twenty-nine older women (mean age, 74.2 years) who were involved in a randomized controlled walking intervention from 1982 to 1985 were subsequently followed up until December 1999. Physical activity was assessed in 1985, 1995, and 1999 using a physical activity questionnaire and a physical activity monitor. In 1999, functional status was assessed by self-report and performance-based measures. RESULTS: Subjective and objective measures of physical activity in 1985 independently predicted gait speed in 1999 after controlling for age, chronic conditions, and activity limitation (subjective model-adjusted R2 = 0.09 [P=.03]; and objective model-adjusted R2 = 0.13 [P=.008]). The consistency of physical activity participation from 1985 to 1995 was also related to functional status in 1999. Women who were always active had the best functional status and women who were always inactive had the worst functional status. For difficulty with activities of daily living: those always active, 17 (37.8%) of 45 women; those inconsistently active, 24 (40.0%) of 60 women; and those always inactive, 39 (59.1%) of 66 women (chi2 for trend P=.02). For score on the Physical Performance Test: those always active, 24.9; those inconsistently active, 24.5; and those always inactive, 23.8 (analysis of variance with linear contrasts P=.04). For gait speed: those always active, 1.17 m/s; those inconsistently active, 1.15 m/s; and those always inactive, 1.03 m/s (analysis of variance with linear contrasts P=.002). CONCLUSION: We demonstrated a significant relation between physical activity during a 14-year period and current functional status in older women, thus suggesting that physical activity plays a role in maintaining functional ability later in life.     

Effectiveness of physical activity and sedentary behaviour interventions in altering sedentary behaviour among older adults: a systematic review

Background

Long and frequent bouts of sedentary behaviour pose a major risk to health and increase the incidence of hypokinetic diseases and mortality, independent of the risks caused by physical inactivity alone. The aim of this systematic review was to determine the effectiveness of interventions used by researchers in altering sedentary behaviour among adults aged 60 years or older.

Physical activity, physical fitness and the effect of exercise training interventions in lymphoma patients: a systematic review

Fatigue is one of the most common and most distressing problems in lymphoma patients. A vicious circle is presumed between fatigue, physical activity and physical fitness. It is plausible that an exercise training program would be effective in reducing fatigue, by breaking this vicious circle. The purposes of this review are to provide an overview of the literature on physical activity and physical fitness in lymphoma patients before, during and after anticancer treatment, and to summarise the literature on exercise training interventions in lymphoma patients. We conducted a search for studies reporting on physical activity, physical fitness or the effect of exercise training in lymphoma patients. A total of 13 articles were selected. Due to a small number of articles and methodological issues, it was not possible to make final conclusions. The results indicated that 21 % to 29 % of lymphoma survivors meet the American College of Sports Medicine public health guidelines for physical activity. Maximal exercise capacity was decreased before treatment, especially in patients with advanced disease, and was close to normal during and/or after treatment. Lower levels of physical activity as well as lower physical fitness seemed to be associated with more symptoms of fatigue. Aerobic exercise training interventions seemed to be feasible and safe and had positive effects on cardiorespiratory fitness, fatigue and self-reported physical functioning. Further research is needed to examine physical activity and physical fitness in a longitudinal, objective way in large samples and to examine the effect of exercise training in lymphoma patients.     

Facilitators and barriers for recruiting and engaging hard-to-reach older people to health promotion interventions and related research: a systematic review

BackgroundOlder people from particular groups engage less in health promotion interventions and related research, potentially generating inequities. This review aimed to identify barriers and facilitators to participation in health promotion interventions or health promotion-related research in groups of older people known to participate less.MethodsWe focused on older people from black and minority ethnic groups, older people in deprived areas, and those aged 85 years and older (oldest-old). We searched Medline, Cochrane Library, SCOPUS, Embase, PsychINFO, SSCI, CINAHL, and SCIE databases (Jan 1, 1990, to Dec 31, 2014) to identify eligible studies reporting facilitators and barriers of recruiting or engaging any of the three groups in health interventions or health promotion-related research (see appendix for search terms). Eligible study designs included surveys, qualitative interviews and focus groups, and mixed methods. Recruitment and engagement strategies reported were identified and analysed thematically for each group. Themes were identified by two researchers independently and agreed with the team.Findings34 studies (three with oldest-old, 24 with black and minority ethnic groups, five within deprived areas, one with both oldest-old and black and minority ethnic groups, one with both oldest-old and deprived areas) were included. Half of studies reported mainly on recruitment; half on engagement. 16 studies focused on participation in interventions; 18 studies were on participation in related research. Facilitators for recruiting in deprived areas included targeting social aspects of participation and providing a personalised approach. Similarly, building trust was important for recruitment from black and minority ethnic groups and oldest-old. Facilitators for engaging black and minority ethnic groups included involving community leaders and recruitment during existing activities; for the oldest-old gaining family support was important. Facilitators across all groups included use of incentives and well-targeted advertising. Barriers among black and minority ethnic groups included fear of falling, poor knowledge of benefits, lack of self-confidence, family responsibilities, and cultural barriers (language, mixed-sex sessions, religious practices). Barriers among the oldest-old included tiredness and feeling too old for preventive health care. Negative social interaction with research staff was a barrier identified in deprived areas only. Barriers across all groups were lack of motivation, deteriorating health, costs, and lack of transportation.InterpretationThis review has identified numerous facilitators and barriers for recruiting and engaging hard-to-reach older people in health promotion interventions and related research; these include specific facilitators and barriers for particular groups, which should be considered in practice.FundingThis study was funded by the National Institute for Health Research (NIHR). AL is funded by the NIHR School for Public Health Research.     

Physical activity for chronic pancreatitis: a systematic review

BackgroundChronic pancreatitis (CP) is a progressive inflammatory disorder of the pancreas. Sarcopenia is a degenerative loss of skeletal muscle mass, quality, and strength and is commonly associated with chronic pancreatitis. Regular physical activity and adequate functional fitness have been found to ameliorate the risk and effects of sarcopenia in other chronic diseases. The objective of this systematic review was to collate all the published evidence which has examined any type of physical activity as an intervention in the chronic pancreatitis patient population.MethodsThis systematic review was conducted in accordance with the PRISMA guidelines. The search strategy was designed by the medical librarian (DM) for Embase and then modified for the other search platforms. Two of the researchers (BM) and (AM) then performed the literature search using the databases Embase, Medline, CINAHL, and Web of Science.ResultsAn electronic identified a total of 571 references imported to Covidence as 420 when the duplicates (151) were removed. 420 titles were screened and 390 were removed as not relevant from their titles. 30 full text papers were selected and from these, only one full text paper was deemed suitable for inclusion.ConclusionsThere is currently insufficient evidence to advise physical activity in the chronic pancreatitis population. However, given the evidence to support physical activity in many other chronic diseases this review highlights the need for urgent investigation of physical activity as an intervention on this specific patient population.     

Smoking and all-cause mortality in older people: systematic review and meta-analysis

BACKGROUND Smoking is an established risk factor of premature death. However, most pertinent studies primarily relied on middle-aged adults. We performed a systematic review and meta-analysis of the empirical evidence on the association of smoking with all-cause mortality in people 60 years and older. METHODS A systematic literature search was conducted in multiple databases including MEDLINE, EMBASE, and ISI Web of Knowledge and complemented by cross-referencing to identify cohort studies published before July 2011. Core items of identified studies were independently extracted by 2 reviewers, and results were summarized by standard methods of meta-analysis. RESULTS We identified 17 studies from 7 countries. Current smoking was associated with increased all-cause mortality in all studies. Relative mortality (RM) compared with never smokers ranged from 1.2 to 3.4 across studies and was 1.83 (95% CI, 1.65-2.03) in the meta-analysis. A decrease of RM of current smokers with increasing age was observed, but mortality remained increased up to the highest ages. Furthermore, a dose-response relationship of the amount of smoked cigarettes and premature death was observed. Former smokers likewise had an increased mortality (meta-analysis: RM, 1.34; 95% CI, 1.28-1.40), but excess mortality compared with never smokers clearly decreased with duration of cessation. Benefits of smoking cessation were evident in all age groups, including subjects 80 years and older. CONCLUSIONS Smoking remains a strong risk factor for premature mortality also at older age. Smoking cessation is beneficial at any age.     

A systematic review of the effectiveness of interventions to help older people adhere to medication regimes

BACKGROUND: Non-adherence is a common cause of treatment failure. The causes and context of non-adherence may differ amongst older people and reviews of interventions to improve adherence have tended to focus on the younger adult population. OBJECTIVE: To conduct a systematic review of interventions to aid adherence to medication for older people over the age of 65. METHOD: Relevant papers identified by searching the Cochrane Database of Systematic Reviews and the Database of Abstracts of Review of Effectiveness (Cochrane Library), Medline 1966-October 2002, Embase 1980-October 2002, Best Evidence, PsychINFO 1887-October 2002 and CINAHL 1982-October 2002. These were then hand-searched. The papers that fitted our inclusion criteria were selected. Two independent reviewers using an established tool assessed the studies for methodological quality. A non-statistical narrative approach was then taken to analyse the studies due to the heterogeneity of the outcome measures. RESULTS: 7 studies were identified. They used a variety of approaches involving external cognitive supports and/or educational interventions. Most studies were of poor methodological quality. Statistically significant effects, where present, tended to have small effects clinically. CONCLUSIONS: Currently there is no strong evidence to support the use of any one intervention type. Future research should use combinations of approaches, as there is some evidence that these are more likely to be successful.