What interventions keep older people out of nursing homes? A systematic review and meta-analysis

• Published in: Journal of the American Geriatrics Society (JAGS) 2023-11, Vol.71 (11), p.3609-3621
• Main Authors: Gaugler, Joseph E, Zmora, Rachel, Peterson, Colleen M, Mitchell, Lauren L, Jutkowitz, Eric, Duval, Sue
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aging in place; Cognitive ability; Community nursing; Drug therapy; Elder care; Geriatrics; Health care; Home health care; Homes for the Aged; Hospitalization; Humans; Independent Living; Institutionalization; Meta-analysis; Nursing care; Nursing Homes; Older people; Systematic review
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.18522

Nursing home admission remains a central outcome in many healthcare systems and community-based programs. The objective of this meta-analysis was to determine the efficacy of pharmacological and nonpharmacological interventions in preventing nursing home admission for adults aged 65 years or older. MEDLINE, EMBASE, PsycInfo, CINAHL, and the Cochrane Library were all last searched in March 2022 to identify up-to-date eligible studies for the meta-analysis. Two reviewers screened each abstract independently. In instances where reviewers disagreed as to inclusion, all reviewers convened to review the Abstract to come to a consensus decision regarding inclusion. Two reviewers independently collected data from each report. Disagreements were resolved using group consensus. The first author reviewed the narrative descriptions of intervention components to create a categorization scheme for the various interventions evaluated in selected studies. These categorizations were reviewed with the co-authors (second-fifth) and collapsed to create the final classification of intervention type. Study risk of bias was assessed using an instrument developed based on Agency for Healthcare Research & Quality (AHRQ) guidance. Differences between the percentages of participants in treatment versus control arms was the outcome of interest. Two-hundred and eighty-three studies with a total of 203,735 older persons were included in the meta-analysis. Specialty geriatrics care (OR = 0.77, 95% CI, 0.60-0.99), multicomponent interventions (OR = 0.82, 95% CI, 0.67-0.99), and cognitive stimulation (OR = 0.60, 95% CI, 0.38-0.96) were associated with less frequent nursing home admission. Home-based and inpatient/discharge management interventions approached statistical significance but were not associated with reduced institutionalization. Even in the face of complex care needs, older adults wish to live at home. Effectively disseminating and implementing geriatric care principles across healthcare encounters could achieve a highly valued and preferred outcome in older adulthood: aging in place.