Background
Methods
Study selection criteria
Search strategy
Study process
Risk of Bias assessment
GRADE - quality of evidence
Data extraction
Data analysis
Results
Search results
Patient and study characteristics
Author, Country & year | Study type | Type of Surgery | Sample Size (n) | Number of patients | Age (years) | Sex (Male) | |||
---|---|---|---|---|---|---|---|---|---|
Intervention | Control | Intervention | Control | Intervention-% | Control-% | ||||
Partridge [17], UK, 2017 | RCT | Vascular | 176 | 85 | 91 | 75 ± 6 | 75 ± 6 | 76.9 | 75.2 |
Hempenius, [13]Netherlands, 2013 | RCT | Cancer | 297 | 148 | 149 | 77 ± 6 | 77 ± 7 | 37.8 | 34.2 |
Hempenius, [23]Netherlands, 2016 | RCT | Cancer | 260 | 127 | 133 | 77 ± 6 | 77 ± 7 | 40.2 | 36.1 |
Chen [10], China, 2017 | Cluster RCT | Abdominal | 377 | 197 | 180 | 74 ± 5 | 74 ± 6 | 56.4 | 57.2 |
McDonald [15], USA, 2018 | PC | Abdominal | 326 | 183 | 143 | 75 ± 6 | 71 ± 6 | 51.0 | 46.6 |
Cronin [11] USA, 2011 | PC | General or Vascular | 69 | 26 | 43 | 75 a | 77 a | 46.2 | 23.3 |
Adogwa [22], USA, 2017 | RC | Spine (lumber) | 125 | 100 | 25 | 73 ± 6 | 73 ± 4 | 41.0 | 36.0 |
Tarazona-Santabalbina [19], Spain, 2019 | RC | Colorectal Cancer | 310 | 203 | 107 | 77 ± 4 | 75 ± 5 | 63.1 | 61.7 |
Nussbaum [16], USA, 2014 | RC | Abdominal (pancreatico- duodenectomy) | 242 | 100 | 142 | 65 ± 10 | 62 ± 11 | 39.0 | 47.0 |
Olsson [24], Sweden, 2014 | Pre-post | THA | 266 | 128 | 138 | 68 ± 12 | 66 ± 13 | 35.6 | 35.5 |
Souwer [18], Netherlands, 2018 | Pre-post | Colorectal cancer (Laparoscopic surgery) | 224 | 86 | C1–63 | 80.6 (6.2) | C1–81.4 (7.3) | 42.0 | C1–52.0 |
C2–75 | C2–79.7(5) | C2–51.0 |
Study quality assessment – risk of bias
GRADE evaluation
The different comprehensive geriatric care models
Geriatric care model | POPS (Harari et al) [31] | POSH (McDonald et al) [15] | HELP (Inouye et al) [14] | gPCC (Ekman et al) [12] | LIFE (Hempenius et al) [13] | MDCa |
---|---|---|---|---|---|---|
Author, study type | Partridge,[17]RCT | Chen [10], Cluster RCT | Olsson [24], Pre-post | Pre-post | ||
Pre-operative | 1. CGA 2. Assessment of Cognitive Function, Frailty, Anaemia, Cardiac evaluation | 1. CGA 2. Risk assessment focused on -• Cognition• Mobility • Functional status • Co-morbidities Medications • Nutrition • Hydration • Pain • Advanced care planning | 1. CGA 2. Screened for 6 delirium risk factors: • Cognitive impairment • Immobility • Sleep deprivation • Dehydration • Vision impairment • Hearing impairment | 1. CGA includes: • Need for additional support after discharge • ADL level • Social lifestyle • Symptoms severity 2.Patient - provider joint Rx plan | 1. CGA 2. Checklist to standardize intervention • Mobility • Co-morbidities • Nutrition • Loss of vision & hearing •Medication • Depression •Incontinence • Cognitive, social & instrumental ADL • Delirium ICP | 2. Rehab care included training, dietary, cognitive, & emotional guidance [18] 3. Nutritional assessment [19] 4. Risk assessment for functional (VES) & polypharmacy status [11] |
Post-operative | • CGA • ICP • Home visit follow-up therapy | • Mx of co-morbidity & pain • Delirium assessment • Enhancement of mobility & nutrition • Counselling for discharge & post-hospital care assessment | • Orientation • Therapeutic activities • Early mobilization • Feeding assistance • Sleep enhancement • Vision & hearing reinforcement •Delirium | • Shared decision: Patient-provider partnership •Documentation: Decisions & assessments according to PCC | • Geriatric nurse daily visit | • Follow-up using postoperative order set assessing functionality, pain & medication [11] •Nutritional assessment & FTRP [16] |
Polypharmacy | NR | Reduction recorded | NR | NR | NR | Recorded [18] |
Delivery team | •Geriatrician • Nurse specialist •Occupational therapist | • Geriatrician • Nurse • Surgeons •Anaesthesiologists | • Geriatrician • Geriatric nurse • Pharmacist • Nutritionist • Rehab therapists • Trained volunteers | • Physicians • Surgeons • Nurse •Physiotherapists •Occupational therapists • Patient representatives | •Geriatrician • Geriatric nurse | •Geriatrician • Geriatric nurse • Oncology nurse • Surgeons • Residents • Dieticians • Physical therapists |