BACKGROUND: Comprehensive Geriatric Assessment (CGA) is now the accepted gold standard for caring for frail older people in hospital. However, there is uncertainty about identifying and targeting suitable recipients and which patients benefit the most.
OBJECTIVES: our objectives were to describe the key elements, principal measures of outcome and the characteristics of the main beneficiaries of inpatient CGA.
METHODS: we used the Joanna Briggs Institute umbrella review method. We searched for systematic reviews and meta-analyses describing CGA services for hospital inpatients in the Cochrane Database of Systematic Reviews, Database of Reviews of Effectiveness (DARE), MEDLINE and EMBASE and a range of other sources.
RESULTS: we screened 1,010 titles and evaluated 419 abstracts for eligibility, 143 full articles for relevance and included 24 in a final quality and relevance check. Thirteen reviews, reported in 15 papers, were selected for review. The most widely used definition of CGA was: 'a multidimensional, multidisciplinary process which identifies medical, social and functional needs, and the development of an integrated/co-ordinated care plan to meet those needs'. Key clinical outcomes included mortality, activities of daily living and dependency. The main beneficiaries were people ≥55 years in receipt of acute care. Frailty in CGA recipients and patient related outcomes were not usually reported.
CONCLUSIONS: we confirm a widely used definition of CGA. Key outcomes are death, disability and institutionalisation. The main beneficiaries in hospital are older people with acute illness. The presence of frailty has not been widely examined as a determinant of CGA outcome.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
BACKGROUND: Falls are common events in older people, which cause considerable morbidity and mortality. Non-pharmacological interventions are an important approach to prevent falls. There are a large number of systematic reviews of non-pharmacological interventions, whose evidence needs to be synthesized in order to facilitate evidence-based clinical decision making. OBJECTIVES: To systematically examine reviews and meta-analyses that evaluated non-pharmacological interventions to prevent falls in older adults in the community, care facilities and hospitals. METHODS: We searched the electronic databases Pubmed, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, PsycINFO, PEDRO and TRIP from January 2009 to March 2015, for systematic reviews that included at least one comparative study, evaluating any non-pharmacological intervention, to prevent falls amongst older adults. The quality of the reviews was assessed using AMSTAR and ProFaNE taxonomy was used to organize the interventions. RESULTS: Fifty-nine systematic reviews were identified which consisted of single, multiple and multifactorial non-pharmacological interventions to prevent falls in older people. The most frequent ProFaNE defined interventions were exercises either alone or combined with other interventions, followed by environment/assistive technology interventions comprising environmental modifications, assistive and protective aids, staff education and vision assessment/correction. Knowledge was the third principle class of interventions as patient education. Exercise and multifactorial interventions were the most effective treatments to reduce falls in older adults, although not all types of exercise were equally effective in all subjects and in all settings. Effective exercise programs combined balance and strength training. Reviews with a higher AMSTAR score were more likely to contain more primary studies, to be updated and to perform meta-analysis. CONCLUSIONS: The aim of this overview of reviews of non-pharmacological interventions to prevent falls in older people in different settings, is to support clinicians and other healthcare workers with clinical decision-making by providing a comprehensive perspective of findings.
ANTECEDENTES: La intervención no farmacológica (por ejemplo, intervenciones multidisciplinares, musicoterapia, terapia de luz brillante, las intervenciones educativas, etc.) son intervenciones alternativas que se pueden utilizar en los sujetos de edad avanzada. Hay un montón de comentarios intervenciones no farmacológicas para la prevención y el tratamiento del delirio en pacientes de mayor edad y los médicos necesitan un documento sintetizado, metodológicamente adecuado para su toma de decisiones.
Métodos y resultados: Se realizó una revisión sistemática de las revisiones sistemáticas (SR) de los estudios comparativos relativos a la intervención no farmacológica para tratar o prevenir el delirio en pacientes de edad avanzada. La base de datos PubMed, Cochrane de sistemáticas, EMBASE, CINHAL, y PsychINFO críticas (28 de abril de 2014) en busca de artículos pertinentes. AMSTAR se utilizó para evaluar la calidad de los SR. El enfoque GRADE se utilizó para evaluar la calidad de los estudios primarios. Se identificaron los elementos de las intervenciones de múltiples componentes y comparados entre los diferentes estudios para explorar la posibilidad de llevar a cabo un meta-análisis. Los índices de riesgo se calcularon mediante un modelo de efectos aleatorios. Veinticuatro los SR con 31 estudios primarios cumplían los criterios de inclusión. Sobre la base de los criterios AMSTAR doce resultaron opiniones de calidad moderada y tres resultaron de alta calidad. En general, las intervenciones no farmacológicas de varios componentes redujo significativamente la incidencia de delirio en las salas de cirugía [2 ensayos aleatorios (ECA): riesgo relativo (RR) 0,71, 95% intervalo de confianza (IC) 0,59 a 0,86; I 2 = 0%; (GRADE prueba: moderada)] y en salas de medicina [2 ECC: RR 0,65, IC del 95%: 0,49 a 0,86; I 2 = 0%; (GRADE prueba: moderada)]. No hay evidencia que apoya la eficacia de las intervenciones no farmacológicas para prevenir el delirio en las poblaciones de bajo riesgo (es decir, baja tasa de delirio en el grupo de control) [1 ECA .: RR 1,75; IC del 95%: 0,50 a 6,10 (pruebas GRADO: muy bajo )]. Para los pacientes que han desarrollado el delirio, la evidencia disponible no apoya la eficacia de las intervenciones no farmacológicas para tratar el delirio de varios componentes. Entre las intervenciones de un solo componente de educación, sólo el personal, protocolo de reorientación (evidencia grado: muy bajo)] y software Geriátrica Evaluación de riesgos de guía de medicamento [cociente de riesgos 0,42; IC del 95%: 0,35 a 0,52, (evidencia GRADE: moderado)] resultó eficaz en la prevención del delirio.
Conclusiones: En los pacientes mayores de componentes múltiples intervenciones no farmacológicas, así como la intervención algunos de los solo-componentes fueron eficaces en la prevención del delirio, pero no para tratar el delirio.
Comprehensive Geriatric Assessment (CGA) is now the accepted gold standard for caring for frail older people in hospital. However, there is uncertainty about identifying and targeting suitable recipients and which patients benefit the most.
OBJECTIVES:
our objectives were to describe the key elements, principal measures of outcome and the characteristics of the main beneficiaries of inpatient CGA.
METHODS:
we used the Joanna Briggs Institute umbrella review method. We searched for systematic reviews and meta-analyses describing CGA services for hospital inpatients in the Cochrane Database of Systematic Reviews, Database of Reviews of Effectiveness (DARE), MEDLINE and EMBASE and a range of other sources.
RESULTS:
we screened 1,010 titles and evaluated 419 abstracts for eligibility, 143 full articles for relevance and included 24 in a final quality and relevance check. Thirteen reviews, reported in 15 papers, were selected for review. The most widely used definition of CGA was: 'a multidimensional, multidisciplinary process which identifies medical, social and functional needs, and the development of an integrated/co-ordinated care plan to meet those needs'. Key clinical outcomes included mortality, activities of daily living and dependency. The main beneficiaries were people ≥55 years in receipt of acute care. Frailty in CGA recipients and patient related outcomes were not usually reported.
CONCLUSIONS:
we confirm a widely used definition of CGA. Key outcomes are death, disability and institutionalisation. The main beneficiaries in hospital are older people with acute illness. The presence of frailty has not been widely examined as a determinant of CGA outcome.
Síntesis amplia»Revisión panorámica de revisiones sistemáticas
