Effectiveness of interventions for managing multiple high-burden chronic diseases in older adults: a systematic review and meta-analysis
ABSTRACT 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 pulmon...
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| Veröffentlicht in: | Canadian Medical Association journal (CMAJ) 2018-08, Vol.190 (34), p.E1004-E1012 |
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| creator | Kastner, Monika, PhD Hayden, Leigh, MD PhD Cardoso, Roberta, PhD Lai, Yonda, MN Treister, Victoria, MPH Hamid, Jemila S., PhD Straus, Sharon E., MD MSc Wong, Geoff, MBBS MD(Res) Ivers, Noah M., MD PhD Liu, Barbara, MD Marr, Sharon, MD MED Holroyd-Leduc, Jayna, MD |
| description | ABSTRACT 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; 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%). 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 ben |
| doi_str_mv | 10.1503/cmaj.171391 |
| format | Article |
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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; 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%). 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 HbA1c , reduce depressive symptoms, improve health-related functional status, and increase the use of mental health services. Protocol registration PROSPERO-CRD42014014489</description><identifier>ISSN: 0820-3946</identifier><identifier>EISSN: 1488-2329</identifier><identifier>DOI: 10.1503/cmaj.171391</identifier><identifier>PMID: 30150242</identifier><language>eng</language><publisher>Canada: Joule Inc</publisher><subject>Age ; Aged ; Analysis ; Arthritis ; Bibliometrics ; Cardiovascular disease ; Care and treatment ; Chronic Disease - therapy ; Chronic diseases ; Chronic illnesses ; Chronic obstructive pulmonary disease ; Clinical trials ; Comorbidity ; Continuity of care ; Cost of Illness ; Dementia ; Depression - prevention & control ; Depression - therapy ; Diabetes ; Elderly patients ; Evidence-based medicine ; Health aspects ; Health services utilization ; Heart failure ; Humans ; Internal Medicine ; Intervention ; Intervention (Psychology) ; Kidney diseases ; Mental depression ; Mental health ; Mental Health Services ; Meta-analysis ; Older people ; Patient Care Management ; Patients ; Peer review ; Physical Functional Performance ; Population ; Primary care ; Psychological aspects ; Quality of Life ; Randomized Controlled Trials as Topic ; Risk factors ; Systematic review</subject><ispartof>Canadian Medical Association journal (CMAJ), 2018-08, Vol.190 (34), p.E1004-E1012</ispartof><rights>Joule Inc. or its licensors</rights><rights>2018 Joule Inc. or its licensors.</rights><rights>COPYRIGHT 2018 Joule Inc.</rights><rights>Copyright Joule Inc Aug 27, 2018</rights><rights>2018 Joule Inc. or its licensors 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c695t-30daef10b15837153f6536517785823cfa0894474c8981673f931577a1dc36423</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110649/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110649/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30150242$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kastner, Monika, PhD</creatorcontrib><creatorcontrib>Hayden, Leigh, MD PhD</creatorcontrib><creatorcontrib>Cardoso, Roberta, PhD</creatorcontrib><creatorcontrib>Lai, Yonda, MN</creatorcontrib><creatorcontrib>Treister, Victoria, MPH</creatorcontrib><creatorcontrib>Hamid, Jemila S., PhD</creatorcontrib><creatorcontrib>Straus, Sharon E., MD MSc</creatorcontrib><creatorcontrib>Wong, Geoff, MBBS MD(Res)</creatorcontrib><creatorcontrib>Ivers, Noah M., MD PhD</creatorcontrib><creatorcontrib>Liu, Barbara, MD</creatorcontrib><creatorcontrib>Marr, Sharon, MD MED</creatorcontrib><creatorcontrib>Holroyd-Leduc, Jayna, MD</creatorcontrib><title>Effectiveness of interventions for managing multiple high-burden chronic diseases in older adults: a systematic review and meta-analysis</title><title>Canadian Medical Association journal (CMAJ)</title><addtitle>CMAJ</addtitle><description>ABSTRACT 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; 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%). 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 HbA1c , reduce depressive symptoms, improve health-related functional status, and increase the use of mental health services. Protocol registration PROSPERO-CRD42014014489</description><subject>Age</subject><subject>Aged</subject><subject>Analysis</subject><subject>Arthritis</subject><subject>Bibliometrics</subject><subject>Cardiovascular disease</subject><subject>Care and treatment</subject><subject>Chronic Disease - therapy</subject><subject>Chronic diseases</subject><subject>Chronic illnesses</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Clinical trials</subject><subject>Comorbidity</subject><subject>Continuity of care</subject><subject>Cost of Illness</subject><subject>Dementia</subject><subject>Depression - prevention & control</subject><subject>Depression - therapy</subject><subject>Diabetes</subject><subject>Elderly patients</subject><subject>Evidence-based medicine</subject><subject>Health aspects</subject><subject>Health services utilization</subject><subject>Heart failure</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Intervention</subject><subject>Intervention (Psychology)</subject><subject>Kidney diseases</subject><subject>Mental depression</subject><subject>Mental health</subject><subject>Mental Health Services</subject><subject>Meta-analysis</subject><subject>Older people</subject><subject>Patient Care Management</subject><subject>Patients</subject><subject>Peer review</subject><subject>Physical Functional Performance</subject><subject>Population</subject><subject>Primary care</subject><subject>Psychological aspects</subject><subject>Quality of Life</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Risk factors</subject><subject>Systematic 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Monika, PhD</creator><creator>Hayden, Leigh, MD PhD</creator><creator>Cardoso, Roberta, PhD</creator><creator>Lai, Yonda, MN</creator><creator>Treister, Victoria, MPH</creator><creator>Hamid, Jemila S., PhD</creator><creator>Straus, Sharon E., MD MSc</creator><creator>Wong, Geoff, MBBS MD(Res)</creator><creator>Ivers, Noah M., MD PhD</creator><creator>Liu, Barbara, MD</creator><creator>Marr, Sharon, MD MED</creator><creator>Holroyd-Leduc, Jayna, MD</creator><general>Joule Inc</general><general>CMA Impact, 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of interventions for managing multiple high-burden chronic diseases in older adults: a systematic review and meta-analysis</title><author>Kastner, Monika, PhD ; Hayden, Leigh, MD PhD ; Cardoso, Roberta, PhD ; Lai, Yonda, MN ; Treister, Victoria, MPH ; Hamid, Jemila S., PhD ; Straus, Sharon E., MD MSc ; Wong, Geoff, MBBS MD(Res) ; Ivers, Noah M., MD PhD ; Liu, Barbara, MD ; Marr, Sharon, MD MED ; Holroyd-Leduc, Jayna, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c695t-30daef10b15837153f6536517785823cfa0894474c8981673f931577a1dc36423</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Age</topic><topic>Aged</topic><topic>Analysis</topic><topic>Arthritis</topic><topic>Bibliometrics</topic><topic>Cardiovascular disease</topic><topic>Care and treatment</topic><topic>Chronic Disease - therapy</topic><topic>Chronic diseases</topic><topic>Chronic illnesses</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Clinical trials</topic><topic>Comorbidity</topic><topic>Continuity of care</topic><topic>Cost of Illness</topic><topic>Dementia</topic><topic>Depression - prevention & control</topic><topic>Depression - therapy</topic><topic>Diabetes</topic><topic>Elderly patients</topic><topic>Evidence-based medicine</topic><topic>Health aspects</topic><topic>Health services utilization</topic><topic>Heart failure</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Intervention</topic><topic>Intervention (Psychology)</topic><topic>Kidney diseases</topic><topic>Mental depression</topic><topic>Mental health</topic><topic>Mental Health Services</topic><topic>Meta-analysis</topic><topic>Older people</topic><topic>Patient Care Management</topic><topic>Patients</topic><topic>Peer review</topic><topic>Physical Functional Performance</topic><topic>Population</topic><topic>Primary care</topic><topic>Psychological 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Canadian Medical Association journal (CMAJ)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kastner, Monika, PhD</au><au>Hayden, Leigh, MD PhD</au><au>Cardoso, Roberta, PhD</au><au>Lai, Yonda, MN</au><au>Treister, Victoria, MPH</au><au>Hamid, Jemila S., PhD</au><au>Straus, Sharon E., MD MSc</au><au>Wong, Geoff, MBBS MD(Res)</au><au>Ivers, Noah M., MD PhD</au><au>Liu, Barbara, MD</au><au>Marr, Sharon, MD MED</au><au>Holroyd-Leduc, Jayna, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effectiveness of interventions for managing multiple high-burden chronic diseases in older adults: a systematic review and meta-analysis</atitle><jtitle>Canadian Medical Association journal (CMAJ)</jtitle><addtitle>CMAJ</addtitle><date>2018-08-27</date><risdate>2018</risdate><volume>190</volume><issue>34</issue><spage>E1004</spage><epage>E1012</epage><pages>E1004-E1012</pages><issn>0820-3946</issn><eissn>1488-2329</eissn><abstract>ABSTRACT 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; 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%). 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 HbA1c , reduce depressive symptoms, improve health-related functional status, and increase the use of mental health services. Protocol registration PROSPERO-CRD42014014489</abstract><cop>Canada</cop><pub>Joule Inc</pub><pmid>30150242</pmid><doi>10.1503/cmaj.171391</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0820-3946 |
| ispartof | Canadian Medical Association journal (CMAJ), 2018-08, Vol.190 (34), p.E1004-E1012 |
| issn | 0820-3946 1488-2329 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6110649 |
| source | Journals@Ovid Ovid Autoload; MEDLINE; DOAJ Directory of Open Access Journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Age Aged Analysis Arthritis Bibliometrics Cardiovascular disease Care and treatment Chronic Disease - therapy Chronic diseases Chronic illnesses Chronic obstructive pulmonary disease Clinical trials Comorbidity Continuity of care Cost of Illness Dementia Depression - prevention & control Depression - therapy Diabetes Elderly patients Evidence-based medicine Health aspects Health services utilization Heart failure Humans Internal Medicine Intervention Intervention (Psychology) Kidney diseases Mental depression Mental health Mental Health Services Meta-analysis Older people Patient Care Management Patients Peer review Physical Functional Performance Population Primary care Psychological aspects Quality of Life Randomized Controlled Trials as Topic Risk factors Systematic review |
| title | Effectiveness of interventions for managing multiple high-burden chronic diseases in older adults: a systematic review and meta-analysis |
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