A systematic mapping review of Randomized Controlled Trials (RCTs) in care homes

Abstract

BackgroundA thorough understanding of the literature generated from research in care homes is required to support evidence-based commissioning and delivery of healthcare. So far this research has not been compiled or described. We set out to describe the extent of the evidence base derived from randomized controlled trials conducted in care homes.MethodsA systematic mapping review was conducted of the randomized controlled trials (RCTs) conducted in care homes. Medline was searched for “Nursing Home”, “Residential Facilities” and “Homes for the Aged”; CINAHL for “nursing homes”, “residential facilities” and “skilled nursing facilities”; AMED for “Nursing homes”, “Long term care”, “Residential facilities” and “Randomized controlled trial”; and BNI for “Nursing Homes”, “Residential Care” and “Long-term care”. Articles were classified against a keywording strategy describing: year and country of publication; randomization, stratification and blinding methodology; target of intervention; intervention and control treatments; number of subjects and/or clusters; outcome measures; and results.Results3226 abstracts were identified and 291 articles reviewed in full. Most were recent (median age 6 years) and from the United States. A wide range of targets and interventions were identified. Studies were mostly functional (44 behaviour, 20 prescribing and 20 malnutrition studies) rather than disease-based. Over a quarter focussed on mental health.ConclusionsThis study is the first to collate data from all RCTs conducted in care homes and represents an important resource for those providing and commissioning healthcare for this sector. The evidence-base is rapidly developing. Several areas - influenza, falls, mobility, fractures, osteoporosis – are appropriate for systematic review. For other topics, researchers need to focus on outcome measures that can be compared and collated.

The Optimal Study: Describing the Key Components of Optimal Health Care Delivery to UK Care Home Residents: A Research Protocol

“…This has more to do with historical and political factors than with the optimal configuration for care delivery. One consequence of this has been that, despite the growing number of research studies conducted in long-term care, international collaborative studies been less common 23 .…”

The Aged Residential Care Healthcare Utilization Study (ARCHUS): A Multidisciplinary, Cluster Randomized Controlled Trial Designed to Reduce Acute Avoidable Hospitalizations From Long-Term Care Facilities

“…14,18,21 A 2008 review of evidence on reducing hospitalizations from RAC 17 commented that clinical literature tends to focus on disease-specific interventions whereas health service research literature examines large administrative databases. Systematic reviews of RCTs in RAC have identified largely noncomplex, topic-specific interventions (eg, falls, influenza, mobility) 22 and shown that avoidable hospitalizations do not feature as a primary outcome for multidisciplinary interventions. 23 A 2012 review aimed at avoidable hospitalizations from long-term care 24 commented that the measures studied are not validated in LTC settings.…”

Efeitos de uma terapia cognitivo-motora em idosos institucionalizados

“…Nesta pesquisa, os grupos experimental e controle apresentaram semelhança estatística para os valores iniciais de mobilidade. Quando submetido ao protocolo de estimulação cognitivo-motora, a análise evidenciou melhora promovida pelo tratamento, corroborando a revisão sistemática de Gordon et al 27 Contudo, nas situações de dupla-tarefa, onde a atividade exige uma importante ativação das funções executivas dos sujeitos, o benefício da terapêutica não foi significativo. Este achado é importante e vai de encontro ao já constatado neste estudo, onde não foi observada uma interferência significativa da assistência sobre os escores cognitivos dos sujeitos 28 .…”