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Interventions for managing multiple chronic health conditions in older adults improve health outcomes and mental wellness

Kastner M, Cardoso R, Lai Y, et al.  Effectiveness of interventions for managing multiple high-burden chronic diseases in older adults: A systematic review and meta-analysis Canadian Medical Association Journal. 2018;190(34):E1004-E1012.

Review question

•        Are interventions for managing multiple chronic health conditions in older adults effective in improving health outcomes?

Background

•        Many older adults suffer from multiple chronic health conditions (including diabetes, dementia, depression, chronic obstructive pulmonary disease, cardiovascular disease, arthritis, and heart failure) which require unique planning to meet their healthcare needs.

•        Chronic health conditions are often managed by different interventions that focus on prevention, ongoing management and treatment. While these interventions can improve patient outcomes, each intervention usually focuses on a single chronic health condition.

•        This systematic review seeks to explore the effects of interventions that simultaneously target multiple chronic health conditions in older adults (for example, combining care coordination with information to patients to improve self-management, and telemedicine).  

How the review was done

•        A detailed search of a number of electronic databases was conducted to identify studies published from 1990 up to December 2017. Studies that focused on interventions for multiple chronic health conditions among adults aged 65 and over were included in the review.

•        A total of 53,465 studies were identified in the initial search and 25 were included in the review.

•        The systematic review was funded by the Ontario Ministry of Health and Long-Term Care, the Canadian Institute of Health Research, the University of Toronto and the University of Calgary.

What the researchers found

•        The review found that increasing care coordination for patients with multiple chronic health conditions had the strongest impact on all health outcomes.

•        Instructing patients on self-management and involving a case manager to ensure that patient needs are met led to reduced depressive status and blood sugar levels.  

•        Telemedicine interventions that included patient education led to reduced depressive status and increased use of mental health services.

Conclusion

•        Overall, the review found that older adults with multiple chronic health conditions (specifically diabetes and either depression or cardiovascular disease, or with chronic obstructive pulmonary disease and heart failure) can benefit from care-coordination strategies with or without education.

•        These interventions helped to lower blood sugar levels, reduce depressive symptoms, improve health-related functional status (meaning the older adult’s ability to perform normal daily activities required to meet basic needs, fulfil usual roles, and maintain health and well-being), and increase the use of mental health services.