Trusted evidence. Informed decisions. Better health. Cochrane Database of Systematic Reviews Analysis 4.1. Comparison 4 Oral health (OH) training of people with intellectual disabilities (ID) versus no training, Outcome 1 Gingival inflammation short term (< weeks

Objectives To undertake a realist review of carer‐led oral hygiene interventions for people with intellectual disabilities. This was run parallel with a Cochrane Review. Methods Realist review methods were followed. This was characterized by an iterative process of developing and refining theories of how interventions might work, expressed as context‐mechanism‐outcome configurations. The steps included identifying candidate theories with local and international expert consultation before applying an iterative search strategy. Selection criteria were applied for screening of the abstracts and 10% of the included full texts were screened by the three review members, independently, to ensure adherence to the criteria. Data were extracted in NVivo and synthesized qualitatively to confirm, refute or refine theories about what works, why, in what circumstances and for whom. Results Of the 697 potential sources, 112 studies progressed to full‐text screening, and 58 of those were included in the review. These 58 studies found evidence to support six theories about carer‐led oral hygiene interventions for people with intellectual disabilities, from a starting point of ten candidate theories. This realist review found evidence to support the contention that, in order for carer‐led oral hygiene interventions for people with ID to succeed, there is a need for adequate resources and a system‐level approach; involving carers in design and implementation; tailoring of training to suit carers’ needs and work environments; clearly stating how interventions are expected to work; specifying goals with achievable steps for carers to follow; providing carers with support and feedback on their efforts; acknowledging the physical and emotional toll caring for people with intellectual disabilities has on the well‐being of carers; and repeating training. Conclusions The theories from this realist review will direct future interventions by suggesting the mechanisms and contexts that are important to achieve the intended outcome of improved oral health for people with intellectual disabilities. These are, of course, propositions intended for testing, rather than proven. The parallel use of Cochrane and realist methods provides a unique richness to our hypothesis of what works, for whom, when and how.

Background Drug-drug interactions (DDIs) can lead to medication-related harm, and the older population is at greatest risk. We conducted a systematic review and meta-analysis to estimate DDI prevalence and identify common DDIs in older community-dwelling adults. Methods PubMed and EMBASE were searched for observational studies published between 01/01/2010 and 10/05/2021 reporting DDI prevalence in community-dwelling individuals aged ≥ 65 years. Nursing home and inpatient hospital studies were excluded. Study quality was assessed using the Joanna Briggs Institute critical appraisal tool. Meta-analysis was performed using a random-effects model with logit transformation. Heterogeneity was evaluated using Cochran's Q and I 2 . DDI prevalence and 95% confidence intervals (CIs) are presented. All analyses were performed in R (version 4.1.2). Results There were 5144 unique articles identified. Thirty-three studies involving 17,011,291 community-dwelling individuals aged ≥ 65 years met inclusion criteria. Thirty-one studies reported DDI prevalence at the study-participant level, estimates ranged from 0.8% to 90.6%. The pooled DDI prevalence was 28.8% (95% CI 19.3-40.7), with significant heterogeneity (p < 0.10; I 2 = 100%; tau 2 = 2.13) largely explained by the different DDI identification methods. Therefore, 26 studies were qualitatively synthesised and seven studies were eligible for separate meta-analyses. In a meta-analysis of three studies (N = 1122) using Micromedex ® , pooled DDI prevalence was 57.8% (95% CI 52.2-63.2; I 2 = 69.6%, p < 0.01). In a meta-analysis of two studies (N = 809,113) using Lexi-Interact ® , pooled DDI prevalence was 30.3% (95% CI 30.2-30.4; I 2 = 6.8%). In a meta-analysis of two studies (N = 947) using the 2015 American Geriatrics Society Beers criteria ® , pooled DDI prevalence was 16.6% (95% CI 5.6-40.2; I 2 = 97.5%, p < 0.01). Common DDIs frequently involved cardiovascular drugs, including ACE inhibitor-potassium-sparing diuretic; amiodarone-digoxin; and amiodarone-warfarin. Conclusions DDIs are prevalent among older community-dwelling individuals; however, the methodology used to estimate these events varies considerably. A standardised methodology is needed to allow meaningful measurement and comparison of DDI prevalence.

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