Effectiveness of interventions for managing multiple high-burden chronic diseases in older adults: a systematic review and meta-analysis

被引:87
|
作者
Kastner, Monika [1 ,2 ,3 ]
Cardoso, Roberta [2 ]
Lai, Yonda [2 ]
Treister, Victoria [2 ]
Hamid, Jemila S. [2 ,4 ]
Hayden, Leigh [1 ]
Wong, Geoff [5 ]
Ivers, Noah M. [6 ,7 ,8 ,9 ]
Liu, Barbara [10 ]
Marr, Sharon [11 ,12 ]
Holroyd-Leduc, Jayna [13 ,14 ]
Straus, Sharon E. [2 ,15 ]
机构
[1] St Michaels Hosp, North York Gen Hosp, Knowledge Translat & Implementat Unit, Li Ka Shing Knowledge Inst, Toronto, ON, Canada
[2] St Michaels Hosp, Li Ka Shing Knowledge Inst, North York Gen Hosp, Toronto, ON, Canada
[3] Univ Toronto, Dalla Lana Sch Publ Hlth, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada
[4] McMaster Univ, Clin Epidemiol & Biostat, Hamilton, ON, Canada
[5] Univ Oxford, Nuffield Dept Primary Care Hlth Sci, Oxford, England
[6] Womens Coll Res Inst, Family Pract Hlth Ctr, Toronto, ON, Canada
[7] Womens Coll Hosp, Inst Hlth Syst Solut & Virtual Care, Toronto, ON, Canada
[8] Univ Toronto, Dept Family & Community Med, Toronto, ON, Canada
[9] Univ Toronto, Inst Hlth Policy, Management & Evaluat, Toronto, ON, Canada
[10] Sunnybrook Hlth Sci, Reg Geriatr Program Toronto, Geriatr Med, Toronto, ON, Canada
[11] McMaster Univ, St Peters Hosp, Hamilton Hlth Sci, Hamilton, ON, Canada
[12] McMaster Univ, Div Geriatr Med, Hamilton, ON, Canada
[13] Univ Calgary, Foothills Hosp, Dept Med, Calgary, AB, Canada
[14] Univ Calgary, Foothills Hosp, Dept Community Hlth Sci, Calgary, AB, Canada
[15] Univ Toronto, Dept Med, Toronto, ON, Canada
基金
加拿大健康研究院;
关键词
OBSTRUCTIVE PULMONARY-DISEASE; MAJOR DEPRESSION; CARE MANAGEMENT; KIDNEY-DISEASE; HEALTH-CARE; MULTIMORBIDITY; OUTCOMES; FEASIBILITY; RESIDENTS; DEMENTIA;
D O I
10.1503/cmaj.171391
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
INTRODUCTION: 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. METHODS: 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. RESULTS: 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; I-2 = 0%) and reduced glycosylated hemoglobin (HbA(1c)) levels (mean difference -0.51; 95% CI -0.90 to -0.11; I-2 = 0%), but not mortality (relative risk [RR] 0.79; 95% CI 0.53 to 1.17; I-2 = 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; I-2 = 0%). INTERPRETATION: 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 HbA(1c), reduce depressive symptoms, improve health-related functional status, and increase the use of mental health services.
引用
收藏
页码:E1004 / E1012
页数:9
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