Multidimensional Factors Affecting Homebound Older Adults: A Systematic Review

2020 ◽  
Author(s):  
JuHee Lee ◽  
Yujin Suh ◽  
Yielin Kim
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Factors Affecting ◽  
Homebound Older Adults

scholarly journals Clinical features and outcomes of COVID-19 in older adults: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sunny Singhal ◽  
Pramod Kumar ◽  
Sumitabh Singh ◽  
Srishti Saha ◽  
Aparajit Ballav Dey
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Critically Ill ◽  
Clinical Features ◽  
Older Patients ◽  
Clinical Characteristics ◽  
Meta Analysis ◽  
Severe Infection ◽  
Factors Affecting ◽  
Pooled Prevalence

Abstract Background Few studies have focused on exploring the clinical characteristics and outcomes of COVID-19 in older patients. We conducted this systematic review and meta-analysis to have a better understanding of the clinical characteristics of older COVID-19 patients. Methods A systematic search of PubMed and Scopus was performed from December 2019 to May 3rd, 2020. Observational studies including older adults (age ≥ 60 years) with COVID-19 infection and reporting clinical characteristics or outcome were included. Primary outcome was assessing weighted pooled prevalence (WPP) of severity and outcomes. Secondary outcomes were clinical features including comorbidities and need of respiratory support. Result Forty-six studies with 13,624 older patients were included. Severe infection was seen in 51% (95% CI– 36-65%, I2–95%) patients while 22% (95% CI– 16-28%, I2–88%) were critically ill. Overall, 11% (95% CI– 5-21%, I2–98%) patients died. The common comorbidities were hypertension (48, 95% CI– 36-60% I2–92%), diabetes mellitus (22, 95% CI– 13-32%, I2–86%) and cardiovascular disease (19, 95% CI – 11-28%, I2–85%). Common symptoms were fever (83, 95% CI– 66-97%, I2–91%), cough (60, 95% CI– 50-70%, I2–71%) and dyspnoea (42, 95% CI– 19-67%, I2–94%). Overall, 84% (95% CI– 60-100%, I2–81%) required oxygen support and 21% (95% CI– 0-49%, I2–91%) required mechanical ventilation. Majority of studies had medium to high risk of bias and overall quality of evidence was low for all outcomes. Conclusion Approximately half of older patients with COVID-19 have severe infection, one in five are critically ill and one in ten die. More high-quality evidence is needed to study outcomes in this vulnerable patient population and factors affecting these outcomes.

scholarly journals Clinical Features and Outcomes of COVID-19 in Older Adults: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Sunny Singhal ◽  
Pramod Kumar ◽  
Sumitabh Singh ◽  
Srishti Saha ◽  
Aparajit Ballav Dey
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Critically Ill ◽  
Clinical Features ◽  
Older Patients ◽  
Clinical Characteristics ◽  
Meta Analysis ◽  
Severe Infection ◽  
Factors Affecting ◽  
Pooled Prevalence

Abstract Background Few studies have focused on exploring the clinical characteristics and outcomes of COVID-19 in older patients. We conducted this systematic review and meta-analysis to have a better understanding of the clinical characteristics of older COVID-19 patients.Methods A systematic search of PubMed and Scopus was performed from December 2019 to May 3rd, 2020. Observational studies including older adults (age ≥60 years) with COVID-19 infection and reporting clinical characteristics or outcome were included. Primary outcome was assessing weighted pooled prevalence (WPP) of severity and outcomes. Secondary outcomes were clinical features including comorbidities and need of respiratory support.Result 46 studies with 13,624 older patients were included. Severe infection was seen in 51% (95% CI– 36-65%, I2- 95%) patients while 22% (95% CI– 16-28%, I2- 88%) were critically ill. Overall, 11% (95% CI– 5-21%, I2- 98%) patients died. The common comorbidities were hypertension (48%, 95% CI– 36-60% I2- 92%), diabetes mellitus (22%, 95% CI– 13-32%, I2- 86%) and cardiovascular disease (19%, 95% CI – 11-28%, I2- 85%). Common symptoms were fever (83%, 95% CI– 66-97%, I2-91%), cough (60%, 95% CI– 50-70%, I2- 71%) and dyspnoea (42%, 95% CI– 19-67%, I2- 94%). Overall, 84% (95% CI– 60-100%, I2- 81%) required oxygen support and 21% (95% CI– 0-49%, I2- 91%) required mechanical ventilation. Majority of studies had medium to high risk of bias and overall quality of evidence was low for all outcomes.Conclusion Approximately half of older patients with COVID-19 have severe infection, one in five are critically ill and one in ten die. More high quality evidence is needed to study outcomes in this vulnerable patient population and factors affecting these outcomes.

scholarly journals Factors affecting the decision to investigate older adults with cancer symptoms: a systematic review

2021 ◽  
pp. BJGP.2021.0257
Author(s):  
Daniel Joseph Jones ◽  
Erica di Martino ◽  
Stephen H Bradley ◽  
Blessing Essang ◽  
Scott Hemphill ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Decision Making ◽  
Cognitive Impairment ◽  
Meta Analysis ◽  
Older Age ◽  
Additional Time ◽  
Factors Affecting ◽  
Cancer Symptoms ◽  
Thematic Synthesis

Background: Older age and frailty increase the risk of morbidity and mortality from cancer surgery and intolerance of chemotherapy and radiotherapy. The effect of old age on diagnostic intervals is unknown. However older adults need a balanced approach to the diagnosis and management of cancer symptoms, considering the benefits of early diagnosis, patient preferences and the likely prognosis of a cancer. Aim: To examine the association between older age and diagnostic processes for cancer and the specific factors which affect diagnosis. Design and setting: Systematic literature review. Method: Electronic databases were searched for studies of patients over 65, presenting with cancer symptoms to primary care considering diagnostic decisions. Studies were analysed using thematic synthesis and according to the Synthesis Without Meta-analysis (SWiM) guidelines. Results: Data from 54 studies with 230729 participants are included. The majority of studies suggest an association between increasing age and prolonged diagnostic interval or deferral of a decision to investigate cancer symptoms. Thematic synthesis highlighted three important factors which resulted in uncertainty in decisions involving older adults: frailty, co-morbidities and cognitive impairment. The data suggested patients wished to be involved in decision making, but the presence of cognitive impairment and the need for additional time within a consultation were significant barriers. Conclusion: This systematic review has highlighted uncertainty in the management of older adults with cancer symptoms. Patients and their family wished to be involved in these decisions. Given the uncertainty regarding optimum management of this group of patients, a shared decision-making approach is important.

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