Here is the structured PICO analysis for the tenth article you uploaded:
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Full Title (verbatim and exact):
“What interventions keep older people out of nursing homes? A systematic review and meta-analysis”
Gaugler JE, Zmora R, Peterson CM, Mitchell LL, Jutkowitz E, Duval S
Journal of the American Geriatrics Society 2023; 71(11): 3609–3621
DOI: https://doi.org/10.1111/jgs.18522
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Type of Article:
Systematic review and meta-analysis of 283 randomised controlled trials
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PICO Analysis:
Population:
- Older adults aged ≥65 years
- Total sample: 203,735 participants across 283 studies
- Settings: Primarily community or outpatient, some inpatient
- Most studies conducted in high-income countries, with ~34% from the USA and ~66% international
Intervention:
Varied types of pharmacological and non-pharmacological interventions evaluated to prevent or delay nursing home admission, including:
- Specialty geriatrics inpatient care (e.g. multidisciplinary geriatric units)
- Multicomponent interventions (e.g. combining case management, caregiver support, therapy)
- Cognitive stimulation/remotivation therapy
- Other categories included:
- Home-based support
- Caregiver skills training
- Case management
- Stroke rehab teams
- Drug therapies
- Exercise programs
- Day hospitals
- Emergency alert systems
Comparator:
- Usual care or placebo
- All included studies were randomised controlled trials with comparator arms
Outcome:
1. Person-centred outcomes:
- Nursing home admission was the primary or secondary outcome in approximately 49% of studies
- Three intervention types were statistically associated with a reduction in institutionalisation:
- Specialty geriatrics care: OR = 0.77 (95% CI: 0.60–0.99) — low certainty
- Multicomponent interventions: OR = 0.82 (95% CI: 0.67–0.99) — high certainty
- Cognitive stimulation: OR = 0.60 (95% CI: 0.38–0.96) — high certainty
2. Process outcomes:
- Indirectly discussed; interventions such as geriatric assessment and care coordination addressed system-level delivery and support
3. Health system outcomes:
- Policy implication: Delaying nursing home admission could reduce Medicaid expenditure and align with ageing-in-place goals
- Limitations:
- Most studies did not differentiate short-term rehab vs long-stay admissions
- Interventions were heterogenous, and many multicomponent models lacked clarity on the mechanism of benefit
Summary Conclusion:
This large meta-analysis demonstrates that specialty inpatient geriatrics care, multicomponent interventions, and cognitive stimulation therapies are associated with reduced risk of nursing home admission in older adults. While most other interventions had mixed or non-significant findings, the three effective categories support investment in coordinated geriatric care and home/community-based supports. Policymakers and health services may consider prioritising these approaches to support ageing in place.
Life In The Slower Lane 
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