Abstract
BackgroundInstitutionalization is a global phenomenon and its impact on elderly’s quality of life (QoL) is under discussion. This systematic review and meta-analysis evaluated the influence of the institutionalization on elderly’s QoL.MethodsSearches were performed in Medline, Scopus, Web of Science, Lilacs, Cochrane Library and SIGLE by two independent reviewers up to May 2019. The eligibility criteria were based on PECO strategy, considering observational studies in elderly (P), which were (E) or not (C) institutionalized to identify differences in their QoL (O). For qualitative synthesis, data were extracted and risk of bias was evaluated through a validated guideline. Meta-analysis was based on Mean Difference (MD) and Standard Mean Difference (SMD) calculation (p ≤ 0.05). The evidence was quality-tested using Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.ResultsThe initial search identified 3841 articles. Duplicates were removed, titles and abstracts were read and eligibility criteria were applied, remaining 16 sixteen cross-sectional studies that were included for data extraction and qualitative synthesis. Out of 16 articles, 14 evaluated the Health-Related Quality of Life, using Leipad (n = 2), WHOQOL-BREF and/or OLD (n = 8), SF-36 or RAND-36 (n = 4) questionnaires, and two assessed the Oral Health–Related Quality of Life, through GOHAI questionnaire. One eligible article was considered as low risk of bias. In the meta-analysis, 12 studies were included. Leipad questionnaire did not show differences on elderly’s QoL (MD 0.11 [− 0.10, 0.32] I2 = 76%). Differences on elderly’s QoL were detected through WHOQOL-BREF (SMD -0.70 [CI95%: − 0.94, − 0.47] I2 = 93%), WHOQOL-OLD (SMD -1.13 [− 1.47, − 0.80] I2 = 91%) and SF-36/RAND-36 (MD -5.97 [CI95%: − 11.29, − 0.64] I2 = 90%). All studies had very low or low certainty of evidence, since the study design influenced evidence classification, and show high heterogeneity.ConclusionAlthough the institutionalization influences negatively the elderly’s QoL, further well-designed studies are needed to confirm this evidence.
Highlights
Institutionalization is a global phenomenon and its impact on elderly’s quality of life (QoL) is under discussion
The importance of active aging and better QoL for the elderly is evident, there is a lack of family care, which increases the elderly’s institutionalization and, by consequence, increase the number of community-dwelling aged people who became residents of nursing homes [7]
Study design, focused question, registration and protocol A systematic review and meta-analysis were conducted in order to answer the focused question: Does institutionalization interfere with elderly’s quality of life? The focused question was based on Population, Exposure, Comparison and Outcome (PECO) strategy [26]
Summary
Institutionalization is a global phenomenon and its impact on elderly’s quality of life (QoL) is under discussion. There is a concern about the active aging process, in which the continuing participation of aged people on daily activities is enhanced [4]. Active aging refers to keep elderly health and on the control of their daily activities. This may generate better Quality of Life (QoL) [5], represented by favourable perceptions of their position in life, within a cultural context, in relation to their goals, expectations, concerns and desires [6]. The importance of active aging and better QoL for the elderly is evident, there is a lack of family care, which increases the elderly’s institutionalization and, by consequence, increase the number of community-dwelling aged people who became residents of nursing homes [7]. The lack of support and assistance to the elderly during daily activities is suggested as an aggravating factor for stimulating elderly’s institutionalization [7]
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