Steultjens Esther M J, Dekker Joost, Bouter Lex M, Jellema Sandra, Bakker Erica B, van den Ende Cornelia H M
Netherlands Institute for Health Services Research (NIVEL), PO Box 1568, 3500 BN Utrecht, The Netherlands.
Age Ageing. 2004 Sep;33(5):453-60. doi: 10.1093/ageing/afh174.
Occupational therapy might play an important role in maintaining independent living for community dwelling elderly people. The aim of this systematic review is to determine whether occupational therapy improves outcome for people who are >/=60 years and are living independently.
An extensive search in MEDLINE, CINAHL, EMBASE, AMED and SCISEARCH until July 2002 was performed. Studies with controlled and uncontrolled designs were included. Six intervention categories were distinguished and individually analysed using a best-evidence synthesis, based on the type of design, the methodological quality, type of outcome measures and statistical significance of findings.
17 studies were included, ten of which were randomised clinical trials. Six randomised clinical trials had a high methodological quality. Strong evidence is present for the efficacy of advising on assistive devices as part of a home hazards assessment on functional ability. There is some evidence for the efficacy of training of skills combined with a home hazard assessment in decreasing the incidence of falls in elderly people at high risk of falling. Some evidence is available for the efficacy of comprehensive occupational therapy on functional ability, social participation and quality of life. Insufficient evidence is present for the efficacy of counselling the primary caregiver of dementia patients about maintaining the patient's functional abilities.
This review shows that occupational therapy interventions for community dwelling elderly people results in positive outcomes. Future research in the efficacy of occupational therapy in elderly patient groups such as people with dementia is recommended. Furthermore, research into tailoring interventions to the needs of elderly patients is recommended.
职业疗法可能在维持社区居家老年人独立生活方面发挥重要作用。本系统评价的目的是确定职业疗法是否能改善60岁及以上独立生活人群的预后。
检索了MEDLINE、CINAHL、EMBASE、AMED和SCISEARCH等数据库，检索截至2002年7月的文献。纳入了有对照和无对照设计的研究。根据设计类型、方法学质量、结局测量类型和研究结果的统计学意义，区分了六个干预类别，并使用最佳证据综合法进行单独分析。
纳入17项研究，其中10项为随机临床试验。六项随机临床试验的方法学质量较高。有强有力的证据表明，作为家庭危险因素评估的一部分，就辅助设备提供建议对功能能力有效。有一些证据表明，技能培训与家庭危险因素评估相结合，可降低高跌倒风险老年人的跌倒发生率。有一些证据表明，综合职业疗法对功能能力、社会参与和生活质量有效。关于为痴呆症患者的主要照顾者提供有关维持患者功能能力的咨询的有效性，证据不足。
本评价表明，针对社区居家老年人的职业疗法干预可产生积极结果。建议对老年患者群体（如痴呆症患者）中职业疗法的疗效进行进一步研究。此外，建议针对老年患者的需求进行干预措施的调整研究。
