| Title |
Effectiveness of interventions for managing multiple high-burden chronic diseases in older adults: a systematic review and meta-analysis
|
|---|---|
| Published in |
Canadian Medical Association Journal, August 2018
|
| DOI | 10.1503/cmaj.171391 |
| Pubmed ID | |
| Authors |
Monika Kastner, Roberta Cardoso, Yonda Lai, Victoria Treister, Jemila S Hamid, Leigh Hayden, Geoff Wong, Noah M Ivers, Barbara Liu, Sharon Marr, Jayna Holroyd-Leduc, Sharon E Straus |
| Abstract |
More than half of older adults (age ≥ 65 yr) have 2 or more high-burden multimorbidity conditions (i.e., highly prevalent chronic diseases, which are associated with increased health care utilization; these include diabetes [DM], dementia, depression, chronic obstructive pulmonary disease [COPD], cardiovascular disease [CVD], arthritis, and heart failure [HF]), yet most existing interventions for managing chronic disease focus on a single disease or do not respond to the specialized needs of older adults. We conducted a systematic review and meta-analysis to identify effective multimorbidity interventions compared with a control or usual care strategy for older adults. We searched bibliometric databases for randomized controlled trials (RCTs) evaluating interventions for managing multiple chronic diseases in any language from 1990 to December 2017. The primary outcome was any outcome specific to managing multiple chronic diseases as reported by studies. Reviewer pairs independently screened citations and full-text articles, extracted data and assessed risk of bias. We assessed statistical and methodological heterogeneity and performed a meta-analysis of RCTs with similar interventions and components. We included 25 studies (including 15 RCTs and 6 cluster RCTs) (12 579 older adults; mean age 67.3 yr). In patients with [depression + COPD] or [CVD + DM], care-coordination strategies significantly improved depressive symptoms (standardized mean difference -0.41; 95% confidence interval [CI] -0.59 to -0.22; I2 = 0%) and reduced glycosylated hemoglobin (HbA1c) levels (mean difference -0.51; 95% CI -0.90 to -0.11; I2 = 0%), but not mortality (relative risk [RR] 0.79; 95% CI 0.53 to 1.17; I2 = 0%). Among secondary outcomes, care-coordination strategies reduced functional impairment in patients with [arthritis + depression] (between-group difference -0.82; 95% CI -1.17 to -0.47) or [DM + depression] (between-group difference 3.21; 95% CI 1.78 to 4.63); improved cognitive functioning in patients with [DM + depression] (between-group difference 2.44; 95% CI 0.79 to 4.09) or [HF + COPD] (p = 0.006); and increased use of mental health services in those with [DM + (CVD or depression)] (RR 2.57; 95% CI 1.90 to 3.49; I2 = 0%). Subgroup analyses showed that older adults with diabetes and either depression or cardiovascular disease, or with coexistence of chronic obstructive pulmonary disease and heart failure, can benefit from care-coordination strategies with or without education to lower HbA1c, reduce depressive symptoms, improve health-related functional status, and increase the use of mental health services. PROSPERO-CRD42014014489. |
X Demographics
The data shown below were collected from the profiles of 77 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Canada | 29 | 38% |
| United Kingdom | 9 | 12% |
| Spain | 6 | 8% |
| Australia | 6 | 8% |
| United States | 2 | 3% |
| Ireland | 1 | 1% |
| New Zealand | 1 | 1% |
| Colombia | 1 | 1% |
| Netherlands | 1 | 1% |
| Other | 1 | 1% |
| Unknown | 20 | 26% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 48 | 62% |
| Practitioners (doctors, other healthcare professionals) | 15 | 19% |
| Scientists | 11 | 14% |
| Science communicators (journalists, bloggers, editors) | 3 | 4% |
Mendeley readers
The data shown below were compiled from readership statistics for 411 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 411 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 53 | 13% |
| Researcher | 45 | 11% |
| Student > Bachelor | 38 | 9% |
| Student > Ph. D. Student | 30 | 7% |
| Student > Doctoral Student | 25 | 6% |
| Other | 72 | 18% |
| Unknown | 148 | 36% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 91 | 22% |
| Nursing and Health Professions | 53 | 13% |
| Psychology | 21 | 5% |
| Social Sciences | 18 | 4% |
| Economics, Econometrics and Finance | 8 | 2% |
| Other | 43 | 10% |
| Unknown | 177 | 43% |
Attention Score in Context
This research output has an Altmetric Attention Score of 147. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 16 October 2023.
All research outputs
#276,442
of 25,144,989 outputs
Outputs from Canadian Medical Association Journal
#498
of 9,377 outputs
Outputs of similar age
#5,834
of 340,236 outputs
Outputs of similar age from Canadian Medical Association Journal
#14
of 119 outputs
Altmetric has tracked 25,144,989 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 98th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 9,377 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 33.9. This one has done particularly well, scoring higher than 94% of its peers.
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We're also able to compare this research output to 119 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 89% of its contemporaries.