The European Union's Ambient and Assisted Living Joint Programme: An evaluation of its impact on population health and well-being

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Prediction models for hospital readmissions in patients with heart disease: a systematic review and meta-analysis

Objective: To describe the discrimination and calibration of clinical prediction models, identify characteristics that contribute to better predictions and investigate predictors that are associated with unplanned hospital readmissions. Design: Systematic review and meta-analysis. Data source: Medline, EMBASE, ICTPR (for study protocols) and Web of Science (for conference proceedings) were searched up to 25 August 2020. Eligibility criteria for selecting studies: Studies were eligible if they reported on (1) hospitalised adult patients with acute heart disease; (2) a clinical presentation of prediction models with c-statistic; (3) unplanned hospital readmission within 6 months. Primary and secondary outcome measures: Model discrimination for unplanned hospital readmission within 6 months measured using concordance (c) statistics and model calibration. Meta-regression and subgroup analyses were performed to investigate predefined sources of heterogeneity. Outcome measures from models reported in multiple independent cohorts and similarly defined risk predictors were pooled. Results: Sixty studies describing 81 models were included: 43 models were newly developed, and 38 were externally validated. Included populations were mainly patients with heart failure (HF) (n=29). The average age ranged between 56.5 and 84 years. The incidence of readmission ranged from 3% to 43%. Risk of bias (RoB) was high in almost all studies. The c-statistic was 0.8 in 5 models. The study population, data source and number of predictors were significant moderators for the discrimination. Calibration was reported for 27 models. Only the GRACE (Global Registration of Acute Coronary Events) score had adequate discrimination in independent cohorts (0.78, 95% CI 0.63 to 0.86). Eighteen predictors were pooled. Conclusion: Some promising models require updating and validation before use in clinical practice. The lack of independent validation studies, high RoB and low consistency in measured predictors limit their applicability. Prospero registration number: CRD42020159839. Keywords: adverse events; cardiology; risk management

Predicting hospitalisation-associated functional decline in older patients admitted to a cardiac care unit with cardiovascular disease: a prospective cohort study

Up to one in three of older patients who are hospitalised develop functional decline, which is associated with sustained disability, institutionalisation and death. This study developed and validated a clinical prediction model that identifies patients who are at risk for functional decline during hospitalisation. The predictive value of the model was compared against three models that were developed for patients admitted to a general medical ward.; A prospective cohort study was performed on two cardiac care units between September 2016 and June 2017. Patients aged 75 years or older were recruited on admission if they were admitted for non-surgical treatment of an acute cardiovascular disease. Hospitalisation-associated functional decline was defined as any decrease on the Katz Index of Activities of Daily Living between hospital admission and discharge. Predictors were selected based on a review of the literature and a prediction score chart was developed based on a multivariate logistic regression model.; A total of 189 patients were recruited and 33% developed functional decline during hospitalisation. A score chart was developed with five predictors that were measured on hospital admission: mobility impairment = 9 points, cognitive impairment = 7 points, loss of appetite = 6 points, depressive symptoms = 5 points, use of physical restraints or having an indwelling urinary catheter = 5 points. The score chart of the developed model demonstrated good calibration and discriminated adequately (C-index = 0.75, 95% CI (0.68-0.83) and better between patients with and without functional decline (chi; 2; = 12.8, p = 0.005) than the three previously developed models (range of C-index = 0.65-0.68).; Functional decline is a prevalent complication and can be adequately predicted on hospital admission. A score chart can be used in clinical practice to identify patients who could benefit from preventive interventions. Independent external validation is needed

Perioperative Factors Associated With Postoperative Delirium in Patients Undergoing Noncardiac Surgery:An Individual Patient Data Meta-Analysis

IMPORTANCE: Postoperative delirium (POD) is a common and serious complication after surgery. Various predisposing factors are associated with POD, but their magnitude and importance using an individual patient data (IPD) meta-analysis have not been assessed.OBJECTIVE: To identify perioperative factors associated with POD and assess their relative prognostic value among adults undergoing noncardiac surgery.DATA SOURCES: MEDLINE, EMBASE, and CINAHL from inception to May 2020.STUDY SELECTION: Studies were included that (1) enrolled adult patients undergoing noncardiac surgery, (2) assessed perioperative risk factors for POD, and (3) measured the incidence of delirium (measured using a validated approach). Data were analyzed in 2020.DATA EXTRACTION AND SYNTHESIS: Individual patient data were pooled from 21 studies and 1-stage meta-analysis was performed using multilevel mixed-effects logistic regression after a multivariable imputation via chained equations model to impute missing data.MAIN OUTCOMES AND MEASURES: The end point of interest was POD diagnosed up to 10 days after a procedure. A wide range of perioperative risk factors was considered as potentially associated with POD.RESULTS: A total of 192 studies met the eligibility criteria, and IPD were acquired from 21 studies that enrolled 8382 patients. Almost 1 in 5 patients developed POD (18%), and an increased risk of POD was associated with American Society of Anesthesiologists (ASA) status 4 (odds ratio [OR], 2.43; 95% CI, 1.42-4.14), older age (OR for 65-85 years, 2.67; 95% CI, 2.16-3.29; OR for &gt;85 years, 6.24; 95% CI, 4.65-8.37), low body mass index (OR for body mass index &lt;18.5, 2.25; 95% CI, 1.64-3.09), history of delirium (OR, 3.9; 95% CI, 2.69-5.66), preoperative cognitive impairment (OR, 3.99; 95% CI, 2.94-5.43), and preoperative C-reactive protein levels (OR for 5-10 mg/dL, 2.35; 95% CI, 1.59-3.50; OR for &gt;10 mg/dL, 3.56; 95% CI, 2.46-5.17). Completing a college degree or higher was associated with a decreased likelihood of developing POD (OR 0.45; 95% CI, 0.28-0.72).CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis of individual patient data, several important factors associated with POD were found that may help identify patients at high risk and may have utility in clinical practice to inform patients and caregivers about the expected risk of developing delirium after surgery. Future studies should explore strategies to reduce delirium after surgery.</p

Geriatric co-management on cardiac care units: program development, implementation and evaluation

This PhD project will focus on the development and evaluation of a team-based co-management intervention for geriatric patients hospitalized on a non-geriatric hospital unit. The primary aim of this intervention will be to prevent functional decline as a result of hospital admission. For this, the Medical Research Council framework for the development and evaluation of complex interventions will be used. First, a systematic review will evaluate the effect of geriatric in-hospital co-management interventions on functional status and will identify key process, structure and outcomes indicators associated with geriatric co-management. Next, identified indicators will be rated by international geriatric co-management experts in a two-round Delphi study for their appropriateness and feasibility to use for the evaluation of a team-based co-management intervention for geriatric patients admitted to the hospital, and if implemented will be considered likely to improve patient care and outcomes. Based on these results and insights from other published literature, a conceptual co-management model for geriatric patients admitted on a non-geriatric unit will be developed, linking evidence-based interventions to key processes, structures, and outcomes based on an understanding of the causal mechanisms and pathways of functional decline. A controlled before and after study will evaluate the developed co-management model on cardiology and cardiac surgery wards. The primary outcome will be functional status at discharge and one, three and six months post discharge. Secondary outcomes will be mortality, cognition, length of stay, iatrogenic complications, health-related quality of life, quality-adjusted life years and change on risk factors status. A process evaluation will determine the dose, fidelity and reach of the intervention. Participants' experiences will be measured using focus groups and semi-structured interviews focusing on barriers, facilitators, acceptability and feasibility as experienced by intervention participants.status: publishe

The European Union's Ambient and Assisted Living Joint Programme: An evaluation of its impact on population health and well-being

The Ambient Assisted Living Joint Programme, instituted in 2008 by the European Union, aimed to create better living conditions for older adults through the funding of information and communications technology projects. This review aimed to uncover what can be learned from the Ambient Assisted Living Joint Programme by determining (1) the target populations served, (2) technology-based interventions used and (3) effects on health and well-being outcomes. Information from the Ambient Assisted Living catalogue, project websites and deliverables and from papers in PubMed and EMBASE was reviewed. Overall, 152 projects from the first six rounds of funding were identified. Sensors, computers, phones, tablets and televisions were used for various purposes, that is, monitoring, feedback, coaching, reminders and communication. In total, 12 projects reported evaluating health and well-being outcomes; however, these evaluations demonstrated poor methodological quality. Only three projects reported exact values. For all other projects, published evidence on the effect of these projects on health and well-being outcomes was not available.status: publishe

Impact of geriatric co-management programmes on outcomes in older surgical patients: update of recent evidence

To determine the impact of geriatric co-management programmes on outcomes in older patients undergoing a surgical procedure.; Twelve programmes were identified. Time to surgery was decreased in two of four studies [pooled mean difference = -0.7 h (95% CI, -3.1 to 4.4)]. The incidence of complications was reduced in two of seven studies (pooled absolute risk reduction = -4% (95% CI -10 to 2%)). Length of stay was reduced in four of eight studies [pooled mean difference = -1.4 days (95% CI -2.7 to -0.1)]. In-hospital mortality was reduced in one of six studies [pooled absolute risk reduction = -2% (95% CI -4 to -0%)]. Unplanned hospital readmissions at 30 days follow-up was reduced in two of three studies [pooled absolute risk reduction = -3% (95% CI -5 to -0%)].; There was a shorter length of stay, less mortality and a lower readmission rate. However, there was uncertainty whether the results are clinically relevant and the GRADE of evidence was low. It was uncertain whether the outcomes time to surgery and complications were improved. The evidence is limited to hip fracture patients

Systematic review of the structure, process and outcomes of team-based geriatric co-management of older patients

Background: Team-based geriatric co-management refers to a collaboration between a geriatrician or geriatric team and a primary treating physician/team in the prevention and management of geriatric problems through shared responsibility and decision making based on comprehensive geriatric assessment. The aim of this systematic review was to determine the structure and processes associated with team-based geriatric co-management of older inpatients and its effect on mortality, functional status, length of stay and readmissions up to one year follow-up. Methods: Primary studies reporting on team-based geriatric co-management of inpatients aged 65 years or older (or mean age of study sample ≥ 75 years), published in English, Dutch, German, French or Spanish were eligible for inclusion. An independent literature search using databases (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials), reference lists, citation searching and ClinialTrials.gov was performed in October 2015. Results: Sixteen studies, involving 15418 patients, were included from 4 randomized controlled trials (RCT), 1 nonRCT, 8 before-and-after studies 3 retrospective cohort studies. Ten studies used multidisciplinary teams, incorporating a geriatrician and nurse (n = 10), physical therapist (n = 8), social worker (n = 5), occupational therapist (n = 4) or an internist (n = 1). Four studies only used a geriatrician, and 2 did not report team members. The majority of interventions focused on early rehabilitation and discharge planning. One of 8 interventions reduced in-hospital mortality and 2 of 9 interventions reduced mortality up to one year follow-up. Two studies measured functional status at discharge reporting better functionality (n = 1) and more improvement (n = 1) in the intervention group. One study measuring functional status at 3 and 6 months follow-up did not detect a difference. The intervention reduced length of stay in 9 of 13 studies. Hospital readmission up to 1 year follow-up was reduced in 1 of 4 interventions. Conclusions: Geriatricians and nurses are key members of geriatric co-management teams which likely reduce length of stay, but not mortality. Their effect on functional status and readmission has not been adequately investigated. Financial Disclosure (List all funders who provided support for this research) : This systematic review was funded by the KU Leuven Research Council (REF 22/15/028; G-COACH: Geriatric co-management for cardiology patients in the hospital). The KU Leuven Research Council was not actively involved in any of the research activities.status: publishe

Geriatrisch co-management op de afdeling hart- en vaatziekten voorkomt functionele achteruitgang en vermindert het aantal complicaties

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