How does surgery affect dementia?
The review authors included seven studies with a total of 555 participants. Three studies compared models of extended care in inpatient settings with conventional care. Two studies compared an extended care model in inpatient settings and in the home environment after discharge with conventional care. Two studies compared inpatient geriatric-led care with traditional orthopedic-led care. None of the interventions were specifically designed for people with dementia, so the data included in this review come from subgroups of people with dementia or cognitive impairment who participated in randomized controlled trials investigating models for caring for the elderly after hip fractures. The end of follow-up in the studies ranged from the time of hospital discharge to 24 months after discharge.
The review authors estimated that all studies were at high risk of bias in more than one domain. As analyzes of subgroups of larger studies, the analyzes lacked the power to reveal differences between the intervention groups. There were also some significant differences in the participants' baseline characteristics between the intervention and comparison groups. Using the GRADE approach, the review authors downgraded the trustworthiness of the evidence to low or very low for all outcomes.
The effect estimates for almost all comparisons were very inaccurate and the overall confidence for most of the results was very low. There were no data from a study on the primary endpoint health-related quality of life. The trustworthiness for the other primary endpoint, activities of daily living and functional capacity, was of very low trust. Therefore, the review authors are unable to draw reliable conclusions. There was low-confidence evidence that enhanced hospital care and rehabilitation could lower postoperative delirium rates (odds ratio 0.04, 95% confidence interval (CI) 0.01-0.22, 2 studies, n = 141 ) and very low confidence evidence that they are associated with lower rates of some other complications. There was also evidence of low trustworthiness that geriatric-guided care may lead to shorter hospital stays compared to orthopedically-guided care (mean difference 4.00 days, 95% CI 3.61 to 4.39, 1 study, n = 162 ).
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