Does the institutionalization influence elderly's quality of life? A systematic review and meta-analysis

Background Institutionalization 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. Methods Searches 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. Results The 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] I-2 = 76%). Differences on elderly's QoL were detected through WHOQOL-BREF (SMD -0.70 [CI95%: - 0.94, - 0.47] I-2 = 93%), WHOQOL-OLD (SMD -1.13 [- 1.47, - 0.80] I-2 = 91%) and SF-36/RAND-36 (MD -5.97 [CI95%: - 11.29, - 0.64] I-2 = 90%). All studies had very low or low certainty of evidence, since the study design influenced evidence classification, and show high heterogeneity. Conclusion Although the institutionalization influences negatively the elderly's QoL, further well-designed studies are needed to confirm this evidence.