Wells Jennie L, Seabrook Jamie A, Stolee Paul, Borrie Michael J, Knoefel Frank
Geriatric Rehabilitation Unit, Parkwood Hospital, London, ON, Canada.
Arch Phys Med Rehabil. 2003 Jun;84(6):898-903. doi: 10.1016/s0003-9993(02)04930-4.
To examine common clinical problems in geriatric rehabilitation and to make recommendations for current practice based on evidence from the literature.
A CINAHL database and 2 MEDLINE searches were conducted for 1980 to 2001. A fourth search was completed by using the Cochrane database.
One author reviewed the references for relevance and another for quality. A total of 336 articles were considered relevant. Excluded articles were unrelated to geriatric rehabilitation or were anecdotal or descriptive reports on a small number of patients.
The following areas were the major geriatric rehabilitation subtopics identified in the search: frailty, comprehensive geriatric assessment, admission screening, assessment tools, interdisciplinary teams, hip fracture, stroke, nutrition, dementia, and depression. This article focuses on the latter 5 subtopics. The literature was reviewed by using a level-of-evidence framework. Level 1 evidence was a randomized controlled trial (RCT) or meta-analysis or systematic review of RCTs. Level 2 evidence included controlled trials without randomization, cohort, or case-control studies. Level 3 evidence involved consensus statements from experts, descriptive studies, or reports of expert committees.
Of the 336 articles evaluated, 108 were level 1, 39 were level 2, and 189 were level 3. Recommendations were made for each subtopic according to the level of evidence in the specific area. In cases in which several articles were written on a topic with similar conclusions, we selected the articles with the strongest level of evidence, thereby reducing the total number of references.
Frail older patients with hip fracture should receive geriatric rehabilitation. They should also be screened for nutrition, cognition, and depression. Older persons should receive nutritional supplementation when malnourished. If severe dysphagia occurs in stroke patients, gastrostomy tube feeding is superior to nasogastric tube feeding.
探讨老年康复中的常见临床问题，并根据文献证据为当前实践提出建议。
对1980年至2001年的CINAHL数据库进行了检索，并进行了两次MEDLINE检索。第四次检索使用Cochrane数据库完成。
一位作者审查参考文献的相关性，另一位审查质量。共有336篇文章被认为相关。排除的文章与老年康复无关，或是关于少数患者的轶事或描述性报告。
检索中确定的主要老年康复子主题包括：衰弱、老年综合评估、入院筛查、评估工具、跨学科团队、髋部骨折、中风、营养、痴呆和抑郁。本文重点关注后5个子主题。使用证据水平框架对文献进行了综述。一级证据是随机对照试验（RCT）或荟萃分析或RCT的系统评价。二级证据包括非随机对照试验、队列研究或病例对照研究。三级证据包括专家共识声明、描述性研究或专家委员会报告。
在评估的336篇文章中，108篇为一级证据，39篇为二级证据，189篇为三级证据。根据特定领域的证据水平，对每个子主题提出了建议。在针对同一主题撰写了几篇结论相似的文章的情况下，我们选择了证据水平最强的文章，从而减少了参考文献的总数。
髋部骨折的衰弱老年患者应接受老年康复治疗。还应对他们进行营养、认知和抑郁方面的筛查。老年人营养不良时应接受营养补充。中风患者发生严重吞咽困难时，胃造瘘管喂养优于鼻胃管喂养。
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