scholarly journals Rapid review of decision-making for place of care and death in older people: lessons for COVID-19

2020 ◽  
Author(s):  
Emily West ◽  
Kirsten Moore ◽  
Nuriye Kupeli ◽  
Elizabeth L Sampson ◽  
Pushpa Nair ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Older People ◽  
Data Extraction ◽  
Rapid Review ◽  
Current Evidence ◽  
Key Factors ◽  
Full Data ◽  
Review Of Reviews ◽  
Experience Of Illness

Abstract Introduction The coronavirus pandemic (COVID-19) has affected the functioning and capacity of healthcare systems worldwide. COVID-19 has also disproportionately affected older adults. In the context of COVID-19, decision-making surrounding place of care (PoC) and place of death (PoD) in older adults involves significant new challenges. Aims To explore key factors that influence PoC and PoD decisions in older adults. A secondary aim was to investigate key factors that influence the process and outcome of these decisions in older adults. To apply findings from current evidence to the context of COVID-19. Methods Rapid review of reviews, undertaken using WHO guidance for rapid reviews for the production of actionable evidence. Data extracted was synthesised using narrative synthesis, with thematic analysis and tabulation. Results 10 papers were included for full data extraction. These papers were published between 2005 and 2020. Papers included discussed actual PoD, as well as preferred. Results were divided into papers that explored the process of decision-making, and those that explored decision-making outcomes. Conclusions The process and outcomes of decision-making for older people are affected by many factors—all of which have the potential to influence both patients and caregivers experience of illness and dying. Within the context of COVID-19, such decisions may have to be made rapidly and be reflexive to changing needs of systems and of families and patients.

scholarly journals A Rapid Process for Identifying and Prioritizing Technology-Based Tools for Health System Implementation (Preprint)

2018 ◽  
Author(s):  
Emily R Dibble ◽  
Bradley E Iott ◽  
Allen J Flynn ◽  
Darren P King ◽  
Mark P MacEachern ◽  
...  
Keyword(s):  
Decision Making ◽  
Health System ◽  
Review Process ◽  
New Technology ◽  
Rapid Review ◽  
Current Evidence ◽  
Review Panel ◽  
Environmental Scan ◽  
System Leaders ◽  
Evidence Review

BACKGROUND Health system decisions to put new technologies into clinical practice require a rapid and trustworthy decision-making process informed by best evidence. OBJECTIVE This study aimed to present a rapid evidence review process that can be used to inform health system leaders and clinicians seeking to implement new technology tools to improve patient-clinician decision making and patient-oriented outcomes. METHODS The rapid evidence review process we pioneered involved 5 sequential subprocesses: (1) environmental scan, (2) expert panel recruitment, (3) host evidence review panel, (4) analysis, and (5) local validation panel. We conducted an environmental scan of health information technology (IT) literature to identify relevant digital tools in oncology care. We synthesized the recent literature using current evidence review methods, creating visual summaries for use by a national panel of experts. Panelists were taken through a 6-hour modified Delphi process to prioritize tools for implementation. Findings from the rapid evidence review panel were taken to a local validation panel for further rapid review during a 3-hour session. RESULTS Our rapid evidence review process shows promise for informing decision making by reducing the amount of time and resources needed to identify and prioritize adoption of IT tools. Despite evidence of improved patient outcomes, panelists had substantial concerns about implementing patient-reported outcome tracking tools, voicing concerns about liability, lack of familiarity with new technology, and additional time and workflow changes such tools would require. Instead, clinicians favored technologies that did not require clinician involvement. CONCLUSIONS Health system leaders can use the rapid evidence review process presented here to usefully inform local technology adoption, implementation, and use in practice.

The Incidence of SARS-COV-2 Manifestations in the Central Nervous System: A Rapid Review and Meta-Analysis

2020 ◽  
Author(s):  
Verena Mayr ◽  
Glechner Anna ◽  
Gerald Gartlehner ◽  
Irma Klerings ◽  
Peter Lackner
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cohort Studies ◽  
Case Studies ◽  
Data Extraction ◽  
Meta Analysis ◽  
Neurological Complications ◽  
Rapid Review ◽  
Current Evidence ◽  
Treatment Team

Abstract Background: Coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2 and presents itself mainly as a respiratory tract infection. However, reports of associated central nervous system (CNS) manifestations are increasing.Methods: We conducted this rapid review to determine the frequency of CNS manifestations of COVID-19 (CNS symptoms, acute cerebrovascular disease, and infectious/inflammatory CNS diseases) and to summarize the current evidence for direct invasion of the CNS by SARS-CoV-2. An information specialist searched Ovid MEDLINE, the CDC: COVID-19 Research Articles Downloadable and WHO COVID-19 Databases, CENTRAL, and Epistemonikos.org on May 13, 2020. Two reviewers screened abstracts and potentially relevant full-text publications independently. The data extraction, assessment of risk of bias,and certainty of evidence using GRADE was done by one reviewer and double-checked by another. If possible and reasonable, a meta-analysis was carried out.Results: We identified 13 relevant studies (four cohort studies, nine case studies) with a total of 866 COVID-19 patients.In a Chinese cohort, dizziness (16.8%; 36 of 214) and headache (13.1%; 28 of 214) were the most common CNS symptoms reported. A meta-analysis of four cohort studies including 851 COVID-19 patients showed an incidence of 3.3% (95% CI: 2.2–4.9) for ischemic stroke (follow-up: one to five weeks). In 13 of 15 encephalitis case studies, PCR testing of the cerebrospinal fluid did not detect any virus components.Conclusion: CNS manifestations occur frequently in patients with COVID-19. It is important to integrate neurologists into the multiprofessional COVID-19 treatment team to detect neurological complications early and to treat them correctly.

scholarly journals What are the consequences of caring for older people and what interventions are effective for supporting unpaid carers? A rapid review of systematic reviews

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e046187
Author(s):  
Gemma F Spiers ◽  
Jennifer Liddle ◽  
Tafadzwa Patience Kunonga ◽  
Ishbel Orla Whitehead ◽  
Fiona Beyer ◽  
...  
Keyword(s):  
Older People ◽  
Systematic Reviews ◽  
Well Being ◽  
Social Determinant ◽  
Rapid Review ◽  
Current Evidence ◽  
Effective Interventions ◽  
Summary Data ◽  
Social Determinant Of Health

ObjectivesTo identify and map evidence about the consequences of unpaid caring for all carers of older people, and effective interventions to support this carer population.DesignA rapid review of systematic reviews, focused on the consequences for carers of unpaid caring for older people, and interventions to support this heterogeneous group of carers. Reviews of carers of all ages were eligible, with any outcome measures relating to carers’ health, and social and financial well-being. Searches were conducted in MEDLINE, PsycInfo and Epistemonikos (January 2000 to January 2020). Records were screened, and included systematic reviews were quality appraised. Summary data were extracted and a narrative synthesis produced.ResultsTwelve systematic reviews reporting evidence about the consequences of caring for carers (n=6) and assessing the effectiveness of carer interventions (n=6) were included. The review evidence typically focused on mental health outcomes, with little information identified about carers’ physical, social and financial well-being. Clear estimates of the prevalence and severity of carer outcomes, and how these differ between carers and non-carers, were absent. A range of interventions were identified, but there was no strong evidence of effectiveness. In some studies, the choice of outcome measure may underestimate the full impact of an intervention.ConclusionsCurrent evidence fails to fully quantify the impacts that caring for older people has on carers’ health and well-being. Information on social patterning of the consequences of caring is absent. Systematic measurement of a broad range of outcomes, with comparison to the general population, is needed to better understand the true consequences of caring. Classification of unpaid caring as a social determinant of health could be an effective lever to bring greater focus and support to this population. Further work is needed to develop and identify suitable interventions in order to support evidence-based policymaking and practice.

scholarly journals Map the apps: a rapid review of digital approaches to support the engagement of older adults in strength and balance exercises

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Lisa McGarrigle ◽  
Elisabeth Boulton ◽  
Chris Todd
Keyword(s):  
Older Adults ◽  
Older People ◽  
Balance Training ◽  
Evidence Base ◽  
Rapid Review ◽  
Behaviour Change Techniques ◽  
Activity Levels ◽  
Exercise Interventions ◽  
Balance Exercises ◽  
Google Search

Abstract Background Exercise interventions, particularly those targeting strength and balance, are effective in preventing falls in older people. Activity levels are generally below recommended levels and reduce with age. There is concern that exercise levels may be further reduced in the context of the COVID-19 pandemic. Digital approaches may offer a means for older people to engage in strength and balance exercises independently in their own homes. The objective of this review was to identify and evaluate existing apps and websites to support independent engagement in strength and balance exercises by older people. Methods We conducted a rapid review of apps and websites, following PRISMA guidelines. We searched for available apps in the Android and iOS app stores, and performed a database search (MEDLINE and EMBASE) for apps in development. We searched for websites using the Google search engine. Apps and websites were evaluated in terms of existing evidence for effectiveness, use of behaviour change techniques (BCTs), and quality. Results We evaluated 13 apps and 24 websites on the basis of our selection criteria. Considering the evidence-base, quality and BCT scores, four apps and six websites are recommended for use by older people who wish to engage in exercise independently in their own homes. No apps or websites have been to RCT evaluation at the time of review. Conclusions Apps and websites have the potential to provide a convenient, cost-effective, and accessible means for many older adults to engage in strength and balance training and reduce falls risk.

scholarly journals Subjective Memory Complaints and Decision Making in Young and Older Adults: An Event-Related Potential Study

2021 ◽  
Vol 13 ◽  
Author(s):  
Ruth Garrido-Chaves ◽  
Vanesa Perez ◽  
Mario Perez-Alarcón ◽  
Isabel Crespo-Sanmiguel ◽  
Tiago O. Paiva ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Young Adults ◽  
Older People ◽  
Decision Making Process ◽  
Subjective Memory Complaints ◽  
Subjective Memory ◽  
Feedback Processing ◽  
Memory Complaints ◽  
Related Potentials

Subjective memory complaints (SMCs) may affect decision-making processes. This study aimed to investigate the neuronal correlates of feedback processing during a decision-making task in young and older adults with and without SMCs. Event-related potentials and behavioral performance during the Iowa gambling task were recorded in a total of 136 participants (65 young adults, 71 older adults). The participants were divided into two groups according to their SMCs (with SMCs: n = 60, without SMCs: n = 76). Feedback-related negativity (FRN) and P3 were analyzed in the feedback stage of the decision-making process. Older adults with SMCs scored worse in the ambiguity phase than older adults without SMCs. The FRN latency was longer for losses in older people with SMCs than in older people without SMCs in the first block. No significant differences between young and older adults with and without SMCs were observed in the other ERP measures. Compared to young adults, older adults showed delayed latency in the FRN component and reduced amplitudes and delayed latency in the P3 component. In conclusion, older people with SMCs present deficits in the decision-making process. These deficits are observed at the behavioral level, but also in neural mechanisms of early feedback processing of negative outcomes.

scholarly journals Promotion of Physical Activity in Older People Using mHealth and eHealth Technologies: Rapid Review of Reviews

10.2196/22201 ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. e22201
Author(s):  
Lisa McGarrigle ◽  
Chris Todd
Keyword(s):  
Physical Activity ◽  
Older People ◽  
Systematic Reviews ◽  
English Language ◽  
Rapid Review ◽  
Activity Levels ◽  
Increased Risk ◽  
Reduced Physical Activity ◽  
Promotion Of Physical Activity ◽  
Review Of Reviews

Background Older people are at increased risk of adverse health events because of reduced physical activity. There is concern that activity levels are further reduced in the context of the COVID-19 pandemic, as many older people are practicing physical and social distancing to minimize transmission. Mobile health (mHealth) and eHealth technologies may offer a means by which older people can engage in physical activity while physically distancing. Objective The objective of this study was to assess the evidence for mHealth or eHealth technology in the promotion of physical activity among older people aged 50 years or older. Methods We conducted a rapid review of reviews using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched for systematic reviews published in the English language in 3 electronic databases: MEDLINE, CINAHL Plus, and Scopus. Two reviewers used predefined inclusion criteria to select relevant reviews and extracted data on review characteristics and intervention effectiveness. Two independent raters assessed review quality using the AMSTAR-2 tool. Results Titles and abstracts (n=472) were screened, and 14 full-text reviews were assessed for eligibility. Initially, we included 5 reviews but excluded 1 from the narrative as it was judged to be of critically low quality. Three reviews concluded that mHealth or eHealth interventions were effective in increasing physical activity. One review found that the evidence was inconclusive. Conclusions There is low to moderate evidence that interventions delivered via mHealth or eHealth approaches may be effective in increasing physical activity in older adults in the short term. Components of successful interventions include self-monitoring, incorporation of theory and behavior change techniques, and social and professional support.

scholarly journals User-Centered Design and Evaluation of a Web-Based Decision Aid for Older Adults Living With Mild Cognitive Impairment and Their Health Care Providers: Mixed Methods Study (Preprint)

2019 ◽  
Author(s):  
Laura-Mihaela Bogza ◽  
Cassandra Patry-Lebeau ◽  
Elina Farmanova ◽  
Holly O Witteman ◽  
Jacobi Elliott ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Decision Aid ◽  
Personal Values ◽  
Rapid Review ◽  
Values Clarification ◽  
Web Based ◽  
User Centered

BACKGROUND Mild cognitive impairment (MCI) is often considered a transitional state between normal and pathologic (eg, dementia) cognitive aging. Although its prognosis varies largely, the diagnosis carries the risk of causing uncertainty and overtreatment of older adults with MCI who may never progress to dementia. Decision aids help people become better informed and more involved in decision making by providing evidence-based information about options and possible outcomes and by assisting them in clarifying their personal values in relation to the decision to be made. OBJECTIVE This study aimed to incorporate features that best support values clarification and adjust the level of detail of a web-based decision aid for individuals with MCI. METHODS We conducted a rapid review to identify options to maintain or improve cognitive functions in individuals with MCI. The evidence was structured into a novel web-based decision aid designed in collaboration with digital specialists and graphic designers. Qualitative and user-centered evaluations were used to draw on users’ knowledge, clarify values, and inform potential adoption in routine clinical practice. We invited clinicians, older adults with MCI, and their caregivers to evaluate the decision aid in 6 consecutive rounds, with new participants in each round. Quantitative data were collected using the Values Clarity and Informed subscales of the Decisional Conflict Scale, the System Usability Scale, the Ottawa Acceptability questionnaire, and a 5-point satisfaction rating scale. We verified their comprehension using a teach-back method and recorded usability issues. We recorded the audio and computer screen during the session. An inductive thematic qualitative analysis approach was used to identify and describe the issues that arose. After each round, an expert panel met to prioritize and find solutions to mitigate the issues. An integrated analysis was conducted to confirm our choices. RESULTS A total of 7 clinicians (social workers, nurses, family physicians, psychologists) and 12 older (≥60 years) community-dwelling individuals with MCI, half of them women, with education levels going from none to university diploma, were recruited and completed testing. The thematic analysis revealed 3 major issues. First, the user should be guided through the decision-making process by tailoring the presentation of options to users’ priorities using the values clarification exercise. Second, its content should be simple, but not simplistic, notably by using information layering, plain language, and pictograms. Third, the interface should be intuitive and user friendly, utilize pop-up windows and information tips, avoid drop-down menus, and limit the need to scroll down. The quantitative assessments corroborated the qualitative findings. CONCLUSIONS This project resulted in a promising web-based decision aid that can support decision making for MCI intervention, based on the personal values and preferences of the users. Further ongoing research will allow its implementation to be tested in clinical settings.

scholarly journals Map the Apps: a rapid review of digital approaches to support the engagement of older adults in strength and balance exercises

2020 ◽  
Author(s):  
Lisa McGarrigle ◽  
Elisabeth Boulton ◽  
Chris Todd
Keyword(s):  
Older Adults ◽  
Older People ◽  
Balance Training ◽  
Evidence Base ◽  
Rapid Review ◽  
Behaviour Change Techniques ◽  
Activity Levels ◽  
Exercise Interventions ◽  
Balance Exercises ◽  
Google Search

Abstract Background: Exercise interventions, particularly those targeting strength and balance, are effective in preventing falls in older people. Activity levels are generally below recommended levels and reduce with age. There is concern that exercise levels may be further reduced in the context of the COVID-19 pandemic. Digital approaches may offer a means for older people to engage in strength and balance exercises independently in their own homes. The objective of this review was to identify and evaluate existing apps and websites to support independent engagement in strength and balance exercises by older people.Methods: We conducted a rapid review of apps and websites, following PRISMA guidelines. We searched for available apps in the Android and iOS app stores, and performed a database search (MEDLINE and EMBASE) for apps in development. We searched for websites using the Google search engine. Apps and websites were evaluated in terms of existing evidence for effectiveness, use of behaviour change techniques (BCTs), and quality. Results: We evaluated 13 apps and 24 websites on the basis of our selection criteria. Considering the evidence-base, quality and BCT scores, four apps and six websites are recommended for use by older people who wish to engage in exercise independently in their own homes. No apps or websites have been to RCT evaluation at the time of review.Conclusions: Apps and websites have the potential to provide a convenient, cost-effective, and accessible means for many older adults to engage in strength and balance training and reduce falls risk.

scholarly journals Prevalence of Mental Disorders, Cognitive Impairment, and Dementia Among Older Adults in Egypt: Protocol for a Systematic Review (Preprint)

2019 ◽  
Author(s):  
Opeyemi Odejimi ◽  
George Tadros ◽  
Noha Sabry
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Mental Disorders ◽  
Reference Lists ◽  
Data Extraction ◽  
Current Evidence ◽  
Eligibility Criteria ◽  
Prevalence Studies ◽  
Internet Resources ◽  
Current Prevalence

BACKGROUND In Egypt, the population of older adults is rapidly growing. The last census in 2017 indicated that older adults numbered 94.8 million, which is a 2.56% increase from the 2006 census. There is growing evidence that the older population is at greater risk for some forms of mental disorders such as depression, dementia, and many more. OBJECTIVE This study aims to review the current evidence regarding the prevalence of mental disorders among older adults in Egypt. This will be achieved by estimating the current prevalence of mental disorders and identifying any sociodemographic correlations with mental disorders. METHODS An electronic search of 5 key databases (MEDLINE, PsycINFO, EMBASE, AMED, and PubMed) from their date of inception was conducted. In addition, scans of reference lists and searches of key journals, citations, and relevant internet resources were conducted. Studies were included if they were published in English, point prevalence studies, conducted with older Egyptians aged ≥60 years, and conducted using a validated diagnostic tool to ascertain mental disorders. Studies that did not meet any of these criteria were excluded. RESULTS This systematic review started in November 2018. The literature search of the 5 databases revealed 343 papers. After screening titles and abstracts, scanning citations and reference lists, and searching internet sources, a total of 38 full-text articles were accessed, of which 16 studies met the eligibility criteria and were included. We are currently in the process of data extraction and synthesis. CONCLUSIONS This research will help bring the scale of mental disorders among older adults in Egypt to the forefront. This may help ensure evidence-based initiatives are established and that priority is given to resource allocation for geriatric mental health in Egypt. CLINICALTRIAL PROSPERO International Prospective Register of Systematic Review CRD42018114831; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=114831 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/14637

scholarly journals Optimising prescribing practices in older adults with multimorbidity: a scoping review of guidelines

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e049072
Author(s):  
Penny Lun ◽  
Felicia Law ◽  
Esther Ho ◽  
Keng Teng Tan ◽  
Wendy Ang ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Scoping Review ◽  
Data Extraction ◽  
Grey Literature ◽  
Cochrane Library ◽  
Prescribing Practices ◽  
Usable Knowledge ◽  
Study Selection ◽  
The Cochrane Library

ObjectiveInappropriate polypharmacy occurs when multiple medications are prescribed without clear indications or where harms outweigh their benefits. The aims of this scoping review are to (1) identify prescribing guidelines that are available for older adults with multimorbidity and (2) to identify cross-cutting themes used in these guidelines.DesignScoping review.Data sourcesPubMed, Embase, Web of Science, the Cochrane Library databases, Cumulative Index to Nursing and Allied Health Literature, grey literature sources, six key geriatrics journals, and reference lists of identified review papers. The search was conducted in November 2018 and updated in September 2019.Study selectionGeneral prescribing guidelines tailored to or for adults including older adults with multimorbidity.Data extractionData for publication description, guideline characteristics, information for users and criteria were extracted. The synthesis contains summarised qualitative descriptions of the studies and guideline characteristics as well as identified cross-cutting themes.ResultsOur search strategy yielded 10 427 unique citations, of which 70 fulfilled the inclusion criteria for synthesis. Among these, there were 61 unique guidelines and tools which used implicit, explicit, mixed or other approaches in the prescriber decision-making process. There are 11 cross-cutting themes identified in the guidelines. Prescriber-related themes are: conduct a comprehensive assessment before prescribing, identify patients’ needs, goals and priorities, adopt shared decision-making, consider evidence-based recommendations, use clinical prescribing tools, incorporate multidisciplinary inputs and embrace technology-enabled prescribing. Wider organisation-related and system-related themes related to education, training and the work environment are also identified.ConclusionsFrom guidelines and tools identified, eleven cross-cutting themes provide a usable knowledge base when seeking to optimise prescribing among older adults with multimorbidity. Incorporating these themes in an approach that uses mixed criteria and implementation information could facilitate greater uptake of published prescribing recommendations.

Sign in / Sign up

Export Citation Format

Share Document