Leader: Antonella Zambon (UNIMIB); Other collaborator(s): UNIMIB, UNIBA, CNR
Identification of : i) modifiable and not modifiable risk factors of functional and cognitive decline due to hospitalization; ii) intervention or hospital praxis to encourage functional manteinment and independence of older people during hospitalization; iii) costs associated to intervention or hospital praxis to estimate their cost-efficacy. This task will be carried out with different approaches: systematic review and meta-analysis of scientific literature and analysis of pre-existing databases (when possible with a individual data meta-analysis). When possible, the activities will be automated through appropriate algorithms (e.g. text mining) to optimize the update. A survey willbe launched across Italian hospitals to evaluate the usual practices of hospital physicians towards older patients
Brief description of the activities and of the intermediate results
Three systematic reviews with meta-analysis (MA) were conducted to evaluate:
After meetings with experts from various disciplines (neurologists, geriatricians, etc.) a consensus was reached about the various search strings. For first MA 36 articles were eligible for inclusion in the analysis. Thirtytwo studies were in community-dwelling setting, 3 in hospital setting and only 1 in nursing home setting. Only the most frequently reported functional and cognitive outcomes were meta-analyzed: the short physical performance battery [SPPB], the timed up and go test [TUG], the Montreal Cognitive Assessment [MoCA] scale, and the mini-mental state examination test [MMSE]. Improvements in functional and cognitive status in favor of the multi-component intervention compared to the control group were reported for all the outcomes analyzed. However, the only outcome who reached a statistically significant result was the TUG test.
Main policy, industrial and scientific implications
To address the expected impact of biomarkers on efficacy of multi-intervention approach . These results will be useful in eventual ongoing modfification of clinical trials
Brief description of the activities and intermediate results
Significant progress has been made since the last update, particularly in the first and second meta-analyses:
First Meta-Analysis (Effectiveness of Multi-Component Interventions):
Second Meta-Analysis (Role of Multi-Component Interventions on Biomarker Changes):
Subgroup and Sensitivity Analyses:
Main policy, industrial, and scientific implications
The use of the RoB2 method strengthens the credibility of our findings, ensuring that our recommendations for clinical practice are based on high-quality evidence. The preliminary results from these meta-analyses underscore the importance of multi-component interventions in improving functional outcomes and potentially influencing biomarker profiles in older adults. These insights will guide ongoing clinical trials and could influence future policy decisions related to the care of elderly populations.
Next steps
Activty completed.
Manuscript in preparation.