Loneliness prevalence of community-dwelling older adults and the impact of the mode of measurement, data collection, and country: A systematic review and meta-analysis.

OBJECTIVES: The aim of this systematic review and meta-analysis is to assess the prevalence of loneliness in many countries worldwide which have different ways of assessing it. DESIGN: Systematic review and meta-analysis. SETTING: We searched seven electronic databases for English peer-reviewed studies published between 1992 and 2021. PARTICIPANTS: We selected English-language peer-reviewed articles, with data from non-clinical populations of community-dwelling older adults (>60 years), and with "loneliness" or "lonely" in the title. MEASUREMENTS: A multilevel random-effects meta-analysis was used to estimate the prevalence of loneliness across studies and to pool prevalence rates for different measurement instruments, data collection methods, and countries. RESULTS: Our initial search identified 2,021 studies of which 45 (k = 101 prevalence rates) were included in the final meta-analysis. The estimated pooled prevalence rate was 31.6% (n = 168,473). Measurement instrument was a statistically significant moderator of the overall prevalence of loneliness. Loneliness prevalence was lowest for single-item questions and highest for the 20-item University of California-Los Angeles Loneliness Scale. Also, differences between modes of data collection were significant: the loneliness prevalence was significantly the highest for face-to-face data collection and the lowest for telephone and CATI data collection. Our moderator analysis to look at the country effect indicated that four of the six dimensions of Hofstede also caused a significant increase (Power Distance Index, Uncertainty Avoidance Index, Indulgence) or decrease (Individualism) in loneliness prevalence. CONCLUSIONS: This study suggests that there is high variability in loneliness prevalence rates among community-dwelling older adults, influenced by measurement instrument used, mode of data collection, and country.

Executive functions in primary progressive aphasia: A meta-analysis.

Executive functions (EFs) refer to a set of cognitive processes, specifically shifting, inhibition, updating of working memory, and are involved in the cognitive control of behavior. Conflicting results have been reported regarding impairments of EFs in Primary Progressive Aphasia (PPA). We performed a multi-level meta-analysis to confirm whether deficits of EFs exist in this population, focusing on a common EFs composite, and the components shifting, inhibition and updating separately. We included 141 studies that report on 294 EFs tasks. The overall mean weighted effect size was large (d = -1,28), indicating poorer EFs in PPA as compared to age-matched cognitively healthy controls. Differences between effect sizes of the EFs components were not significant, indicating all components are affected similarly. Overall, moderator analysis revealed that PPA variant and disease duration were significant moderators of performance, while task modality and years of education were not. The non-fluent/agrammatic PPA and the logopenic PPA variants were similarly affected, but the semantic variant was affected to a lesser extent. We discuss implications for clinical and research settings, and future research.

Latent class analysis: an innovative approach for identification of clinical and laboratory markers of disease severity among COVID-19 patients admitted to the intensive care unit.

Objective: The aim of this study was to identify clinical and laboratory phenotype distribution patterns and their usefulness as prognostic markers in COVID-19 patients admitted to the intensive care unit (ICU) at Tygerberg Hospital, Cape Town. Methods and results: A latent class analysis (LCA) model was applied in a prospective, observational cohort study. Data from 343 COVID-19 patients were analysed. Two distinct phenotypes (1 and 2) were identified, comprising 68.46% and 31.54% of patients, respectively. The phenotype 2 patients were characterized by increased coagulopathy markers (D-dimer, median value 1.73 ng/L vs 0.94 ng/L; p < 0.001), end-organ dysfunction (creatinine, median value 79 µmol/L vs 69.5 µmol/L; p < 0.003), under-perfusion markers (lactate, median value 1.60 mmol/L vs 1.20 mmol/L; p < 0.001), abnormal cardiac function markers (median N-terminal pro-brain natriuretic peptide (NT-proBNP) 314 pg/ml vs 63.5 pg/ml; p < 0.001 and median high-sensitivity cardiac troponin (Hs-TropT) 39 ng/L vs 12 ng/L; p < 0.001), and acute inflammatory syndrome (median neutrophil-to-lymphocyte ratio 15.08 vs 8.68; p < 0.001 and median monocyte value 0.68 × 109/L vs 0.45 × 109/L; p < 0.001). Conclusion: The identification of COVID-19 phenotypes and sub-phenotypes in ICU patients could help as a prognostic marker in the day-to-day management of COVID-19 patients admitted to the ICU.

Identification of Palliative Care Needs in Cancer Patients in a Surgical Emergency Center.

BACKGROUND: Advanced cancer is associated with a significant symptom burden, and timely identification of palliative care (PC) needs, and provision of appropriate PC can improve treatment outcomes, reduce healthcare cost, and enhance patient and family satisfaction with care. Several tools have been used to identify PC needs in different clinical settings and patient groups. OBJECTIVE: The primary objective was to determine the prevalence and associated characteristics of PC needs among cancer patients admitted to the surgical emergency center (SEC) of a large academic hospital in South Africa (SA). The association between PC needs and early death were explored as a secondary outcome. DESIGN: This was a cross-sectional observational study that included all patients with known malignancy admitted through the SEC for acute surgical emergencies. The validated Supportive and Palliative Care Indicators Tool (SPICT™) was applied to patients' files on admission to the SEC. In addition, attending physicians were asked to estimate the 1 year survival probability of these patients by answering The Surprise Question (SQ). SETTING: A tertiary level, public, academic hospital in Cape Town, SA. RESULTS: One hundred and twelve admissions were included with a median age of 58 years. Fifty-two admissions (46.4%) were for metastatic patients and 60.7% were known with palliative treatment intent. The prevalence of SPICT- and SQ-defined PC needs was 46.4% and 54.7% respectively. Pain was the most prevalent presenting symptom and bowel obstruction the most prevalent presenting diagnosis. SPICT-positivity was a significant predictor of death before discharge and death within 6 months of first admission. Proportional agreement in predicting for PC needs of greater than 70% was shown between the two tools. CONCLUSION: Patients with PC needs comprise a significant proportion of SEC cancer admissions. This study shows the clear need for investment in staff and infrastructure to provide integrated palliative and end-of-life care as part of surgical services. The SPICTTM and SQ were shown to predict for early death in this cohort. Further validation of PC needs assessment tools is needed to guide the cost-effective implementation of PC services in low resource settings.