Challenges in Synthesizing and Interpreting the Evidence from a Systematic Review of Multifactorial Interventions to Prevent Functional Decline in Older Adults

Abstract

A systematic review of multifactorial assessment and management interventions to prevent functional decline in older adults was undertaken for the U.S. Preventive Services Task Force. It was not possible to determine net benefit because of heterogeneity of studies, including how older adults were selected and their risk of functional decline; the broad spectrum and multifactorial nature of interventions evaluated; the suboptimal and inconsistent use of outcomes measured; and the inconsistent and inadequate reporting of data that might allow comparison of populations, interventions, and outcomes between studies. This review process illustrated the complexities encountered when synthesizing and interpreting the evidence in geriatric research and methods of reviewing complex interventions and multiple interrelated health outcomes. This article summarizes the review findings, focusing on methodological challenges, and offers suggestions to researchers on the design, reporting, and analysis of trials that would help address these challenges and allow for better interpretation of evidence in the future.

Cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people: Results of a cluster randomized trial

“…The outcome measure, the modified Katz-ADL index may not be sensitive enough to detect clinically relevant change in disability over time and may poorly discriminate between people with relatively few disabilities in a community-dwelling setting. [53, 54] Besides, the EQ-5D-3L that was used to measure health-related quality of life strongly focusses on health, whereas in older adults aspects of quality of life beyond health, may be more important contributors to quality of life in older people. The Adult Social Care Outcomes Toolkit (ASCOT) is an example of an outcome measure that assesses quality of life from a broader perspective than health alone, and that can be used in economic evaluations of care interventions for older people.…”

Abbreviated Care‐Process Quality Indicator Sets Linked with Survival and Functional Status Benefit in Older Adults Under Ambulatory Care

“…2 The literature on complex interventions to improve functional status also show very small or mixed benefit. 30 It is imperative that better functional status outcomes measures be developed that are more sensitive to medical interventions 31 and quality-of-life measures that reflect older patients' values with late-life disability. 32 Therefore, if a patient highly values preserving function above survival, then the focus might transition to QI sets more closely matched to his/her preferences.…”

Health‐Related Quality of Life and Functional Status Quality Indicators for Older Persons with Multiple Chronic Conditions

“…Little evidence is currently available that addresses whether measuring HRQOL and functional status, or implementing quality indicators using these tools, affects outcomes. 13,14 Although functional status and HRQOL are important outcome measures for people with MCCs, particularly older adults, influencing functional status and HRQOL in people with MCCs is challenging to achieve and to measure, and recent systematic reviews on this topic have found mixed results of healthcare interventions. 13,14 The evidence base may not be sufficiently robust for endorsement of indicators that hold providers accountable for preventing or reversing functional decline in populations of older adults with MCCs in the ambulatory setting.…”