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Poor quality evidence for an increased CVD prevalence, osteoporosis prevalence, and/or risk factors in women 45 years or older with disabilities Critical Summary Prepared by: Susan Parker RDH, B.S., MEd, MBA 

OVERVIEW

  • Systematic Review Conclusion:

    The authors found poor quality evidence for an increased prevalence of cardiovascular disease (CVD) and/or its risk factors among disabled women 45 years or older compared to non-disabled women. Regarding osteoporosis, the review could not support any conclusions because of the lack of related studies.

  • Critical Summary Assessment:

    Because of limited quality or complete absence of evidence, inconsistent definitions for "disability" and small sample sizes that reduced statistical power, no clinical relevance regarding the conclusions can be provided regarding increases in the prevalence of CVD or osteoporosis in women equal to or greater than 45 years old with physical disabilities.

  • Evidence Quality Rating:

    Poor

A Critical Summary of:

Aging with a disability: a systematic review of cardiovascular disease and osteoporosis among women aging with a physical disability

Rosso, A. L., Wisdom, J. P., Horner-Johnson, W., McGee, M. G., Michael, Y. L.. Maturitas. 2011;68(1):65-72

  • Clinical Questions:

    In women 45 years or older with physical disabilities compared to women of the same age or older without physical disabilities, is there an increase in the prevalence of CVD and/or osteoporosis and/or their risk factors ?

  • Review Methods:

    A limited systematic search evaluated the burden of CVD, osteoporosis, and their related factors among woman 45 years or older with physical disabilities. The authors evaluated each outcome separately. They had the following inclusion criteria: (1) presentation of a documented chronic physical disability using female-specific assessment; (2) cardiovascular or osteoporosis outcomes that were not the cause of the disability; (3) empirical evidence but not case studies; and (4) studies conducted in developed countries. One reviewer selected the abstracts, and 10% were randomly checked. It is not clear how many reviewers were involved in the article analysis stage. The authors assessed studies for study quality, excluding those with compromised validity.

  • Main Results:

    The screening process yielded seven CVD and no osteoporosis studies for full-text evidence review.The authors excluded the majority of the articles due to lack of relevance to the review's key questions. Five articles addressed the occurrence of CVD among women with physical disabilities. In general, the prevalence of CVD among women with physical disabilities was similar to comparison groups, although some evidence supported a positive association between disability and CVD. Five articles reported on the prevalence of CVD risk factors among women with physical disabilities. The authors found limited evidence supporting an increased prevalence of CVD risk factors among women with physical disabilities compared to non-disabled women. Only two studies addressed modifying factors for the relationship between a physical disability and CVD or its risk factors, finding that age and duration of disease may modify the association between physical disability and CVD risk factors in aging women. The review did not identify any articles that met the inclusion criteria regarding osteoporosis outcomes in this population.

  • Conclusion:

    The authors found limited evidence for an increased prevalence of CVD and/or its risk factors among woman 45 years or older with a physical disability compared to non-disabled women. Regarding osteoporosis, the review could not support any conclusions because of the lack of related studies.

  • Source of funding:

    No source of funding source.

Commentary:

  • Importance and Context:

    Women live longer than men but experience greater morbidity with age. High quality empirical research is needed to understand the health risks and possible disparities faced by the growing population of women aging with disabilities. CVD and osteoporosis are common problems among elderly persons.

  • Strengths and Weaknesses of the Systematic Review:

    Although the authors applied most of the basic principles for conducting a systematic review, some significant limitations were identified. They only searched one electronic database. Only one reviewer selected articles among the identified abstracts except for 10% of the total abstract sample, which two reviewers analyzed . The reviewers only included English articles. Additionally,they provided no clear explanation about why a meta-analysis was not attempted. Some indication by the authors regarding quality assessment was considered as articles considered to be low quality were excluded.

  • Strengths and Weaknesses of the Evidence:

    Most of the excluded articles addressed aging into a disability rather than aging with a disability. Articles were cross-sectional which limited temporal inferences since there is no aspect of "aging" but only a certain age ( 45 or older). Small sample sizes often hindered the statistical power of the articles. Included studies defined disability differently. Only two studies found limited evidence related to CVD. The authors did not find any articles that met the inclusion criteria for osteoporosis.

  • Implications for Dental Practice:

    Because of the limited evidence, this systematic review could not support an association between women 45 years or older with disabilities and the prevalence of CVD or osteoporosis.

  • Critical Summary Publication Date: 3/18/2013

These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association ©

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