Background
Description of the intervention
Previous systematic reviews
Objectives of this systematic review
Methods
Criteria for considering studies for this review
Types of studies
Types of participants
Context
Intervention/exposure
Comparator/control
Primary outcome
Secondary outcomes
Exclusion criteria
Information sources
Search
Study selection
Data collection
Risk of bias for individual studies
Summary measures
Data synthesis
Results
Study selection
First author, date, country, study design | Inclusion criteria | No. of participants & mean age | Intervention | Duration of intervention & visit frequency | Outcomes & time period | Shortened results (intervention group c/f control) |
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Complex interventions | ||||||
Beland 2006 Canada RCT (2 articles) | Aged ≥64 years; community-dwelling; French or English; participating caregiver; functional disability; no pending RAC admission. | SIPA n = 606 Control n = 624 82 years | SIPA (System of Integrated Care for Older Persons): multidisciplinary teams with full clinical responsibility for delivering comprehensive community-based care & coordination across health and social welfare sectors | Average length of enrolment was 572 days over the 662 day trial | Institutional admission, ED utilized, Skilled RAC utilized. Hospital utilized, Number in hospital waiting RAC placement Baseline & 12 months. | Skilled RAC admissions →. Decreased waiting in hospital for RAC place. Utilization or costs for ED, or acute hospital →. |
Dalby 2000 Canada RCT | Functional impairment or hospital admission or bereavement in the previous 6 mths; aged ≥70 yrs.; at risk of sudden deterioration in health; community dwelling; not involved in other studies or previous nurse visits. | Intervention n = 73 (79.1 yrs) Control n = 69 (78.1 yrs) | Nurse led assessment, care plan development and case management | 14 months Varied as needed by individual | RAC admission; Health services utilization; ED visits; Hospital admissions Baseline, 14mths f/up. | RAC admission →. Health services utilization, visits to ED or overnight hospital admissions →. |
Eloniemi-Sulkava 2001} Finland RCT | Aged ≥65 yrs.; dementia; living at home with informal caregiver; no other severe diseases that might lead to institutionalization. | Intervention n = 53 (78.8 yrs) Control n = 47 (80.1 yrs) | Comprehensive, case managed dementia support for client and carer (nurse led) | 2 years Individualised frequency of contacts from once a month to 5 times a day. | RAC admission; Deaths Baseline, 1 & 2 yr. f/up. | RAC admission at 12 months was reduced. RAC admission at 2 yrs. → . Deaths →. |
Eloniemi-Sulkava 2009 Finland RCT | Spouse caring for a partner with dementia at home; dementia diagnosis; no other severe disease with prognosis < 6 months. | Intervention n = 63 (78 yrs) Control n = 62 (77 yrs) | Comprehensive, case managed dementia support for client and carer (nurse & geriatrician led) | Maximum2 yrs– varied phased recruitment Individualised, could be frequent contact | Admitted to RAC Deaths Baseline, 6, 12 & 24 mths f/up. | RAC admission at 12mths → . Reduced RAC admission at 18mths. RAC admission at 2 yrs. → . Deaths at 24 months →. |
Hammar 2007 Finland Cluster RCT | Aged ≥65 years; discharged from hospital back home with home care services; primary admission diagnosis was not cancer, dementia or psychiatric; able to answer mental status-test | Intervention n = 354 Control n = 314 81.7 yrs | Generic community care and case management (IHCaD-practice) commencing with hospital discharge planning, and tailored to municipalities needs. | 6 month program Frequency unclear | Admitted to RAC; Deaths; Finnish version of ADL; hospital care; HRQoL (NHP & EQ-5D) Baseline, 3 wks & 6 mths f/up | RAC admission at 6mth → . Deaths at 6mths → . ADL change at 6mths → . The EQ-5D change at 6mths → . Hospital care at 3wks & 6mth → . |
Mahoney 2007 USA RCT | Aged ≥65; independently living; history of 2 falls in past year, or 1 injurious fall in past 2 yrs., or gait & balance problems; caregiver in the home. | Intervention n = 174 (79.6 yrs) Control n = 175 (80 yrs) | Multi-factorial falls prevention intervention linking participants to existing medical care & service networks. | 12 month program 2 visits in-home first 3 weeks, then monthly phone contact | RAC admissions; RAC days; Mortality; Barthel scores; Depression (GDS); Hospitalisation; Hospital days; Baseline, 12 mth f/up. | RAC admissions →. Fewer RAC days per year. Hospitalisation →. Hospital days →. Barthel scores →. Mean change in GDS score →. |
Markle-Reid 2013 Canada RCT | Trial 1: > 75 years; eligible for personal support services; not eligible for nursing. Trial 2: > 75 years; eligible for personal support services; at risk for falls. Trial 3: confirmed diagnosis of stroke or transient ischaemic attack in past 18 months; eligible for home care services | Trial 1: Intervention n = 144 Control n = 144 83.8 yrs. Trial 2: Intervention n = 54 Control n = 55 84 yrs. Trial 3: Intervention n = 52 Control n = 49 74.3 yrs | 3 different health promotion, disease prevention interventions targeting functional decline and frailty | Trial 1: 5 home visits over 6mths (nursing) Trial 2: median of 19.5 home visits by the interD team over 6mths Trial 3: median of 24 home visits by the interD team over 12mths | Long term care (RAC) admissions; Mortality; SF-36 score; Depression (CES-D). Baseline, 6 & 12 mths f/up. | Trial 1: RAC long-term care →. Mortality →. Improved SF-36 mental health & emotional components. Reduced depression. Number of falls →. Trial 2: RAC long-term care →. Mortality →. SF-36 scores →. Reduced falls Trial 3: RAC long-term care →. Mortality →. SF-36 scores →. Number of falls →. |
Nakanishi 2018 Japan Cluster-RCT | Aged > 65 years; Home-living patients with diagnosed dementia | Intervention n = 141 (83.7 yrs) Control n = 142 (84.9 yrs) | Challenging behaviour dementia training for care professionals; assessment of client behaviours & unmet needs; action plan; individualised multi-D treatment; behaviour monitoring; case management | 6mth program Could have frequent contacts | RAC placement; Mortality; Challenging behaviour (NPI-NH); Pain (Abbey pain scale); Cognition (SMQ); Barthel Index for ADLs; Medication use Baseline, 6mths | RAC admission →. Mortality →. Challenging behaviours significantly improved in intervention group. Other outcomes →. |
Phung 2013 Denmark RCT | Home-living patients diagnosed within the past 12 months with AD, mixed AD with vascular component or Lewy body dementia; ≥50 years; MMSE score ≥ 20; having one participating primary caregiver. All patients met DSM-IV criteria for dementia, NINCDS-ADRDA criteria for probable AD or McKeith criteria for Lewy body dementia. No severe somatic or psychiatric comorbidities | Intervention n = 163 (76.5 yrs) Control n = 167 (75.9 yrs) | Counselling, training, information and support for patients with mild dementia and their caregivers (DAISY) | 8-12mths program Phone contact every 3–4 weeks, 7 individual sessions, 5 group sessions | Patients: RAC admissions; MMSE; Cornell Depression Scale (CDS); Health related QoL (EQ-VAS); QoL-AD; EuroQoL EQ-5D; Neuropsychiatric Inventory (NPIQ); ADSC-ADLs; Mortality; Carers: Geriatric Depression Scale (GPS); Health related QoL (EQ-VAS); Baseline, 6, 12 & 36 mths f/up. | RAC admission →. MMSE changes →. CDS changes →. EQ-VAS changes→. QoL-AD changes→. NPIQ changes →. ADSC-ADL changes →. Mortality →. |
Samus 2014 USA RCT | Aged 70+ yrs.; English-speaking; community-residing; reliable partner; dementia or other cognitive disease; > 1 unmet need on JHDCNA; not in crisis (no signs of abuse, neglect, risk of danger to self/others) | Intervention n = 110 (84.0 yrs) Control n = 193 (83.9 yrs) | Interdisciplinary team case management, care planning, education & support for people with dementia (MIND) | 18mth program Monthly contact | Days at home; RAC placement; Mortality; QOL-AD; ADRQL-40; QOL-AD-Informant; Neuropsychiatric Inventory (NPIQ); Depression (CSDD) Baseline, 9 & 18 mths f/up. | Increase in mean days at home. Reduced RAC placement or death. [RAC admit not reported separately] Improved self-reported QOL (QOL-AD). Proxy rated QOL (ADRQL-40; QOL-AD-Informant) → . NPS (NPI-Q), or participant depression (CSDD) Intervention →. |
Senior 2014 New Zealand RCT | Age ≥ 65 years (≥55 years for Māori); at high risk of institutionalisation but not placed; communicate in English. | Intervention n = 52 (81.9 yrs) Control n = 53 (83.6 yrs) | Case-managed restorative care service delivered in short-stay residential aged care facilities and at participants’ residences (Promoting Independence Programmes) | 2 yr. program Could have frequent contacts | RAC placements; Deaths Baseline, 24 mths f/up. | RAC placements →. Deaths →. |
Shapiro 2002 USA RCT | Elders on a waiting list for community aged care; scored moderate risk based on Axs of chronic health conditions, ADL limitations, & other measures of physical & psychological impairment. | Intervention n = 40 (77.7 yrs) Control n = 65 (77.1 yrs) | Case managed, early intervention social service program for low-income elders | 18mth program Monthly contact | Institutionalised (RAC admission); Deaths; Depression (12-item Center for Epidemiological Studies Depression scale) Baseline, 3, 6, 9, 12, 15 & 18 mths f/up. | RAC admission →. Death →. Improved OR for RAC admission or death. Depression →. |
Spoorenberg 2018 Netherlands RCT | Age > 75 years; registered with a participating GP; not receiving other integrative care | Intervention n = 747 (80.6 yrs) Control n = 709 (80.8 yrs) Stratified by risk profile | Individualised program to maintain health & independence. Case managed, care plans, self management, information sessions, targeted support (EMBRACE) | 12 mths Could be frequent contacts | Institutionalised (RAC admission); Deaths; Health status (EQ-5D-3 L, INTERMED-E-SA, GFI, Katz-15); Wellbeing (GWI, QoL); Self management (SMAS = 30), PIH-OA) Baseline, 12mths | RAC admission →. Death →. Deterioration in ADLs in intervention group (p = 0.04) Other health status → Wellbeing →. Self management →. |
Single focus interventions | ||||||
Byles 2004 Australia RCT | Veterans or war widows with full entitlements from DVA; aged ≥70 years; community dwelling. | Intervention n = 942 Control n = 627 | Annual or 6 monthly in-home assessments, provision of health materials, and report and liaison with GP. | 3 year program | Permanent admission to a RAC; deaths; SF-36 scores; Hospital admissions; Baseline, 1 yr., 2 yr. & 3 yr. f/up. | Increased permanent RAC admission. Number of deaths →. SF-36 scores →. Hospital admission →. |
Gill 2002 USA RCT | Aged ≥75 years; community dwelling; physically frail; can walk; speak English; MMSE score ≥ 20; life expectancy of > 12 mths; no major health event <6mths | Intervention n = 94 (82.8 yrs) Control n = 94 (83.5 yrs) | Home exercise program led by physical therapist to improve mobility and balance | 6 month program 16 visits over 6 months - varied | RAC admissions; Deaths; Baseline, 3, 7 & 12 months f/up | RAC admission by 12 mth f/up →. Number of days spent in a RAC by 12mths → . Deaths during 12 mth → . |
Hebert 2001 Canada RCT | On Quebec Health Insurance Plan list; Aged > 75 years; community dwelling; born between 1 December & 30 April; spoke English or French | Intervention n = 250 (80.2 yrs) Control n = 253 (80.3 yrs) | Nursing assessment, report and recommendations to GP, monthly phone review | 1 year program Monthly contact | Admitted to RAC; Health service utilization; Functional Measurement Autonomy (SMAF); General Wellbeing Schedule (GWBS); Social provisions scale (SPS); Deaths Baseline, 12 mths f/up. | Admission to RAC → . Mean scores in SMAF, GWBS, SPS → . Deaths Intervention →. Health service utilization →. |
Holland 2005 UK RCT | Aged ≥80 yrs.; emergency hospital admission; discharged to own home or warden controlled accommodation; prescribed ≥2 drugs on discharge; no dialysis treatment. | Intervention n = 429 (85.4 yrs) Control n = 426 (85.5 yrs) | Home visit for medication review and education by pharmacist following hospital discharge | 6–8 week program 2 visits | RAC admissions; Mortality; EQ-5D (QoL); Emergency readmissions; Baseline, 3 & 6 mths f/up. | RAC admissions →. Reduced emergency readmissions. Increased GPs home visits. Deaths →. Change in QoL EQ-5D scores →. |
Lenaghan 2007 UK RCT | > 80 years; living in own home; prescribed ≥4 daily medicines; & ≥ 1 criteria present: living alone; mental confusion vision; hearing impairment;prescribed medicines associated with medication-related morbidity; or prescribed > 7 regular oral medicines. | Intervention n = 68 (84.5 yrs) Control n = 66 (84.1 yrs) | Home visits by pharmacist for medication review and education | 2 visits in 8 weeks | RAC admissions; Deaths; EQ-5D (QoL) Unplanned hospital admissions Baseline, 6 mths f/up. | RAC admissions →. Deaths →. The EQ-5D scores →. Unplanned hospital admissions →. |
Luukinen 2006 Finland RCT | Home dwelling; history of recurrent falls in past year, or at ≥1 risk factor for disability in ADLs or mobility. | Intervention n = 243 Control n = 243 88 yrs | Community exercise program to prevent disability | 18–24 month program Bimonthly contact | RAC admission; Mobility score; Balance impairment; ADL Baseline, end of intervention & f/up. | RAC admission →. Severe mobility restrictions at f/up →. Reduction in impaired balance. Improved mobility scores. ADL score improvement →. |
Newbury 2001 Australia RCT | ≥75 years; attending 1 of 6 GP practice sites; community dwelling; no dementia diagnosis | Control n = 50 (80.76 yrs) Intervention n = 50 (78.96 yrs) | Two annual 75+ Health Assessments with report back to GP | 2 year program Annual assessments | Institution (RAC) admissions; Barthel ADL; Self-rated health; Deaths; Folstein MMS; GDS 15; SF-36 Baseline, 12 mths f/up. | RAC admission →. Barthel ADL → . Self-rated health →. Deaths →. Folstein MMS Intervention →. GDS 15 Intervention →. SF-36 → . |
Pardessus 2002 France RCT | Aged ≥65 yrs.; hospitalized for falling; discharged home; no cognitive impairment; fall not secondary to medical or therapeutic problems; access to phone. | Intervention n = 30 (83.51 yrs) Control n = 30 (82.9 yrs) | Single occupational therapy home visit to address risk of falls | 12mth program 1 x home visit | RAC admissions; Functional autonomy measurement system (SMAF); Total ADL; Total IADL; Recurring fall; Hospitalization for fall; Hospitalization for another cause; Deaths Baseline, 6 & 12 mths f/up | RAC admission →. Total SMAF 6–12 months Intervention →. Total ADL scores at 6 or 12mths → . Total IADL scores at 6 or 12mths → . Total SMAF at 6 or 12mths → . Recurring fall →. Hospitalization for fall →. Hospitalisation for another cause →. Death →. |
Spice 2009 United Kingdom Cluster RCT | Aged ≥65 yrs.; community living; ≥2 falls in previous year; not presenting to ED with most recent fall; life expectancy > 1 yr.; abbreviated mental test score ≥ 7; English speakers. | Controls n = 159 (83 yrs) Primary care n = 136 (83 yrs) Secondary care n = 210 (81 yrs) | Primary care intervention group – GP assessment to identify falls risk; referrals as needed. Secondary care intervention group - multi-disciplinary Day Hospital falls prevention assessment with referrals as needed | 12 months Monthly contact | RAC admissions; Falls; Fall-related hospital admissions; Mobility (Get up & go test) Baseline, 12 mths f/up. | Admission to RAC → Reduced falls.in Secondary Care Gp. Falls in Primary Care Gp → . Mobility score →. Fall-related hospital admissions →. |
Thomas 2007 Canada RCT | Aged ≥75 years; no formal home care services; receiving informal care; not in RAC or other long term care; has a primary caregiver; English speaking; mentally competent. | Intervention (1) n = 175 (80.7 yrs) Intervention (2) n = 170 (80.4 yrs) Control n = 175 (80.7 yrs) | Annual functional assessments with either (1) elders and carers only given results only, or (2) also offered help with referrals | 4 year program Annual contact | Institutional (RAC) admissions; Deaths; Self-efficacy; Self-rated health status; Caregiver burden Baseline, yr1, yr2, yr3, yr4. | RAC admissions →. Deaths →. Self-efficacy →. Self-rated health status →. Caregiver burden →. |
Vass 2005 Denmark RCT | Aged 75-80 yrs.; Non-institutionalised; | Intervention n = 1798 Control n = 1688 75 yr. and 80 yr. cohorts | Educational program for healthcare professionals and GPs in geriatric assessment and recognising early functional decline | 3 year program 6 monthly contact | RAC admissions; Mortality; Functional ability Baseline, 3 yr. f/up. | RAC admissions →. Mortality →. Improved functional ability in the 80 yr. old. Improved functional ability in the 75 yr. olds. |
OTHER RCTs (not clearly complex nor minimal interventions) | ||||||
Caplan 2004 Australia RCT | Aged ≥75 yrs.; discharged from ED; community dwelling. | Intervention n = 370 (82.1 yrs) Control n = 369 (82.4 yrs) | In-home assessment following ED presentation, with 28 days community support from hospital-based MultiD team | 4 weeks | RAC admission; ED admission; Hospital admission; Mortality. Baseline, 3, 6, 12 & 18 months f/up. | RAC admission →. Reduced emergency admission to hospital. Increased time to first ED admission. Mortality →. |
Kono 2012 Japan RCT | Aged ≥65 years; need support to live at home; living at home; not used formal long-term care services for the past 3 months. | Intervention n = 161 (80.3 yrs) Control n = 162 (79.6 yrs) | Routine preventive home visits 6 monthly | Every 6 months for 2 years | Institutional admissions (RAC or group home); Deaths; Admitted to hospital; Decline in ADLs; Depression Baseline, 1 & 2 yr. f/up | Institutionalized at 2 yr. → . Deaths at 2 yrs. → . Hospital admissions →. Less decline in ADLs ability. Reduced depression. Increased utilisation of community long-term care. |
Kono 2004 Japan RCT | Aged > 65; living at home; walk independently; need some assistance to live in the community; went outdoors <3x/wk. | Intervention n = 59 (82.5 yrs) Control n = 60 (82.9 yrs) | Preventive home visits by public health nurses 3 monthly | Home visits every 3 months for 18 months | Living at home; RAC admissions; Mortality; ADLs; Social support; Functional status Baseline, 18 mths f/up. | Living at home →. Admitted to RAC → . Deaths →. Less declining ADLs. Social support →. |
Rockwood 2000 Canada RCT | Frailty (concern about community living, or recent bereavement, or hospitalization, or acute illness); frequent physician contact; multiple medical problems; polypharmacy; adverse drug events; functional impairment or functional decline; diagnostic uncertainty. | Intervention n = 95 (81.4 yrs) Control n = 87 (82.2 yrs) | Implementation of Comprehensive Geriatrician Assessment recommendations by a mobile geriatric assessment team. | 3mth program Range 1–6 contacts | RAC admissions; Goal Attainment Scale (GAS); Deaths Baseline, 3, 6 & 12 mths f/up. | RAC admissions →. Improved Goal Attainment (GAS). Deaths →. |
Scott 2004 USA RCT | Aged ≥60 yrs.; ≥ 11 outpatient clinic visits in the prior 18 months; ≥1 chronic conditions; able to attend clinic; no serious cognitive impairment. | Intervention n = 14 (74.2 yrs) Control n = 149 (74.1 yrs) | Monthly group meetings for education, support & health review led by patients’ GP and a nurse | 2 yr. program Monthly contact | Skilled nursing facility (RAC) admissions; Hospital admissions; Pharmacy services; Health facility visits; ADLs; Self-reported Quality of life; Baseline, 24 mths f/up. | RAC admissions →. Reduced hospital admissions. Reduced emergency visits. Improved self-reported quality of life. Increased self-efficacy. ADLs →. Pharmacy services →. Hospital outpatient visits →. |
Sommers 2000 USA Cluster RCT | Aged > 65; not in RAC; 1+ visit to GP past 3mths; English speaking; Indep in mobility toileting feeding; Dependant in 1+ IADL; 2+ chronic conditions; not terminally ill; no dementia or metastatic disease. | Intervention n = 280 (77 yrs) Control n = 263 (78 yrs) | Collaborative care from a GP, nurse and social worker for chronically ill elders (chronic disease self-management model) | 3 yr. program Contact at least 6 weekly | RAC admissions; Symptom scale; SF-36; Health Activities Questionnaire (HAQ); Depression (GDS); Medication count; Nutrition checklist; Hospital admissions; GP office visits; Deaths; Social activities; Baseline, yr1 & yr2 | RAC admissions →. Reduced hospital admissions. Fewer GP office visits/yr. Symptom scale, SF-36, HAQ, GDS, Medication count and Nutrition checklist Intervention →. Deaths →. |
Stuck 2000 Switzerland RCT | Community living; Age 75+; German speaking; not terminal disease | Intervention n = 264 82 yrs. Control n = 527 81.5 yrs | Annual geriatric assessments with quarterly preventative home visits by a nurse | 3 yr. program 3 monthly contact | RAC admissions; Functional status; Mortality Baseline, 1 yr., 2 yr., 3 yr. f/up. | RAC admissions →. Dependent in ADL or iADLs →. Mortality →. |
Van Hout 2010 The Netherlands RCT | Aged ≥75 yrs.; living at home; meet criteria for frailty | Intervention n = 331 (81.3 yrs) Control n = 320 (81.5 yrs) | Geriatric assessments by nurses, personalized care plans and preventative home visiting | 18mth program 3 monthly contact | Institutional (RAC) admissions; Deaths; Hospital admissions; SF-36; ADL; IADL; Emergency visits Baseline, 6 & 18 mths f/up. | RAC admission →. Death →. Hospital admissions →. Emergency visits →. ADLs & iADLs →. |
Types of control conditions
Types of interventions and targeted participants
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Re-enablement or restorative care. Seven RCTs (8 articles), n = 2,842 participants trialled interventions targeting people who had falls [21, 27, 32, 33]), broader mobility issues [26], or aimed for more general functional restoration [39, 40, 43]. Four of these RCTs (five articles) also appear in the complex intervention sub-group, and three in the minimal intervention sub-group.
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Dementia specific interventions. Four RCTs specifically targeted people with dementia and their family carers. Four of these studies fitted our criteria for complex interventions [24, 25, 28, 30]. One dementia study did not provide case management or refer participants to external support services, but did provide semi-individualised counselling, training and information to support people through the early months after dementia diagnosis [29].
Types of outcomes
Risk of bias within RCTs
Author, year | Sequence generation | Allocation concealment | Blinding of participants and personnel | Blinding of outcome assessors | Incomplete outcome data | Selective outcome reporting |
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Beland 2006 | L | ? | ? | L | L | ? |
Byles 2004 | L | ? | H | L | L | ? |
Caplan 2004 | L | H | ? | H | L | ? |
Dalby 2000 | L | L | L | L | L | ? |
Eloniemi-Sulkava 2001 | L | L | ? | L | L | ? |
Eloniemi-Sulkava 2009 | L | L | ? | ? | L | ? |
Gill 2002 | L | ? | ? | L | L | ? |
Hammar 2007 | L | ? | ? | H | L | ? |
Hebert 2001 | L | ? | L | L | L | ? |
Holland 2005 | L | L | H | ? | L | ? |
Kono 2004 | L | ? | L | L | L | ? |
Kono 2012 | L | ? | ? | ? | L | ? |
Lenaghan 2007 | ? | ? | ? | ? | L | ? |
Luukinen 2007 | L | ? | ? | L | L | ? |
Mahoney 2007 | L | L | ? | L | L | ? |
Markle-Reid 2013 | L | ? | ? | ? | ? | ? |
Nakanishi 2018 | L | L | H | H | L | ? |
Newbury 2001 | L | L | H | ? | L | L |
Pardessus 2002 | L | ? | ? | ? | L | ? |
Phung 2013 | ? | ? | ? | L | L | ? |
Rockwood 2000 | ? | ? | H | L | ? | ? |
Samus 2014 | L | ? | H | L | L | ? |
Scott 2004 | L | ? | ? | ? | L | ? |
Senior 2014 | ? | L | H | L | L | ? |
Shapiro 2002 | L | ? | H | H | L | ? |
Sommers 2000 | L | ? | H | ? | H | ? |
Spice 2009 | L | ? | ? | ? | L | ? |
Stuck 2000 | L | L | ? | L | L | ? |
Spoorenberg 2018 | L | ? | H | L | L | ? |
Thomas 2007 | L | ? | H | H | L | L |
van Hout 2010 | L | ? | H | L | L | ? |
Vass 2005 | L | ? | H | H | L | ? |
Results from RCTs
Meta-analysis results
Residential aged care admission outcomes
Intervention sub-group analysis of residential aged care admission
Mortality outcomes
Quality of life outcomes
Duration of program
Narrative synthesis of other RCT outcomes
Health service usage outcomes
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Caplan et.al. [35] reported 44.4% of their intervention group versus 54.3% of the control group had an emergency hospital admission over 18 months [Difference % (95% CI)] -9.9 (− 17.1 to − 2.7) p = 0.007.
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Scott et.al. [50] reported utilization as mean (standard deviation) hospital admissions per patient over 24 months, with significantly less utilization in the intervention group 0.44 ± 0.89 compared to controls 0.82 ± 1.7 (p = 0.013).
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Sommers et al. [49] reported over a 1 year period hospital readmissions for participants in the intervention group decreased from 6 to 4%, while the rate increased in the control group from 4 to 9% (p = 0.03)
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Holland et al. [36] reported a shift in health service utilization. At 6 months 234 hospital readmissions had occurred in the intervention group versus 178 in the control group (rate ratio = 1.30, (95% CI 1.07 to 1.58), p = 0.009. Concurrently GPs carried out 204 home visits in the intervention group and 125 in the control group, a difference of 43% (rate ratio = 1.43 (95% CI 1.14 to 1.80), p = 0.002).
Functional ability outcomes
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In their small, initial study which was not clearly a complex nor a minimal intervention, Kono and colleagues [52] showed that intervention group subjects were less likely to show a decline in ADLs than control group subjects (p = .033).
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In their later RCT Kono’s group reported that for participants who had some dependency at baseline, those in the intervention group were significantly less likely to deteriorate over 2 years in their functional ADLs (p = .0311) or IADLs (p = .0114), compared to controls [53].
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Vass and colleagues [22] reported in their minimal intervention study that 85 year olds in their intervention group had better functional ability after 3 years than those in the control group [Odds Ratio 1.53 (95% CI 1.12–2.09), p = 0.008]; however there was no significant effect in younger participants.
Depression outcomes
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Kono and colleagues [53] reported that for participants who had some ADL dependency at baseline, those in the intervention group (which was not clearly a complex nor a minimal intervention) were significantly less likely to deteriorate over 2 years in relation to experiencing depression (p = 0.0001)
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In one complex intervention arm conducted by Markle-Reid et.al. [21], intervention group participants had a statistically significant reduction in the Center for Epidemiologic Studies Depression Scale score than controls (− 2.72 (95% CI − 0.39 to − 5.07)), p = 0.022.