Proctor R, Burns A, Powell H S, Tarrier N, Faragher B, Richardson G, Davies L, South B
Withington Hospital, Manchester, UK.
Lancet. 1999 Jul 3;354(9172):26-9. doi: 10.1016/S0140-6736(98)08237-3.
As more and more elderly people are being cared for in residential and nursing homes, how best can their psychiatric needs be met? We report on evaluation of a behavioural intervention by an old-age psychiatry hospital outreach team.
This randomised controlled trial of a training and education intervention over 6 months was done in south Manchester, UK. 12 matched nursing and residential homes were randomised to the control or intervention group and within each, the staff selected 10 residents whose behavioural problems made them difficult to care for. Care staff in the intervention homes attended seminars from the hospital outreach team and received weekly visits from a psychiatric nurse to assist in developing care planning skills. The main outcome measures were cognitive impairment and depression, behavioural disturbance, and functional ability, assessed by the geriatric mental state schedule, Crichton Royal behaviour rating scale, and Barthel index, respectively.
Residents in the intervention group had significantly improved scores for depression (before-and-after change difference -0.5 [95% CI -0.8 to -0.1]) and for cognitive impairment (-0.7 [-1.1 to -0.2]) but not for behaviour rating or Barthel index.
Elderly residents can benefit from improved quality of care achieved by training from a hospital outreach team.
随着越来越多的老年人在养老院和护理院接受照料，如何才能最好地满足他们的精神需求？我们报告了一家老年精神病医院外展团队对一种行为干预措施的评估情况。
这项在英国曼彻斯特南部进行的为期6个月的培训与教育干预随机对照试验中，12家匹配的护理院和养老院被随机分为对照组和干预组，每组中，工作人员挑选出10名因行为问题导致照料困难的居民。干预组养老院的护理人员参加了医院外展团队举办的研讨会，并每周接受一名精神科护士的探访，以协助培养护理计划技能。主要结局指标分别通过老年精神状态量表、克莱顿皇家行为评定量表和巴氏指数评估认知障碍、抑郁、行为障碍和功能能力。
干预组居民的抑郁得分（前后变化差值为-0.5 [95%置信区间-0.8至-0.1]）和认知障碍得分（-0.7 [-1.1至-0.2]）有显著改善，但行为评定或巴氏指数得分没有改善。
老年居民可以从医院外展团队的培训所带来的护理质量改善中受益。
