Melis René J F, van Eijken Monique I J, Teerenstra Steven, van Achterberg Theo, Parker Stuart G, Borm George F, van de Lisdonk Eloy H, Wensing Michel, Rikkert Marcel G M Olde
Radboud University Nijmegen Medical Centre, Department of Geriatric Medicine, Nijmegen, The Netherlands.
J Gerontol A Biol Sci Med Sci. 2008 Mar;63(3):283-90. doi: 10.1093/gerona/63.3.283.
The effectiveness of community-based geriatric intervention models for vulnerable older adults is controversial. We evaluated a problem-based multidisciplinary intervention targeting vulnerable older adults at home that promised efficacy through better timing and increased commitment of patients and primary care physicians. This study compared the effects of this new model to usual care.
Primary care physicians referred older people for problems with cognition, nutrition, behavior, mood, or mobility. One hundred fifty-one participants (mean age 82.2 years, 74.8% women) were included in a pseudocluster randomized trial with 6-month follow-up for the primary outcomes. Eighty-five participants received the new intervention, and 66 usual care. In the intervention arm, geriatric nurses visited patients at home for geriatric assessment and management in cooperation with primary care physicians and geriatricians. Modified intention-to-treat analyses focused on differences between treatment arms in functional abilities (Groningen Activity Restriction Scale-3) and mental well-being (subscale mental health Medical Outcomes Study [MOS]-20), using a mixed linear model.
After 3 months, treatment arms showed significant differences in favor of the new intervention. Functional abilities improved 2.2 points (95% confidence interval [CI], 0.3-4.2) and well-being 5.8 points (95% CI, 0.1-11.4). After 6 months, the favorable effect increased for well-being (9.1; 95% CI, 2.4-15.9), but the effect on functional abilities was no longer significant (1.6; 95% CI, -0.7 to 3.9).
This problem-based geriatric intervention improved functional abilities and mental well-being of vulnerable older people. Problem-based interventions can increase the effectiveness of primary care for this population.
基于社区的老年干预模式对弱势老年人的有效性存在争议。我们评估了一种针对居家弱势老年人的基于问题的多学科干预措施，该措施有望通过更好的时机安排以及患者和初级保健医生更高的参与度来提高疗效。本研究将这种新模式的效果与常规护理进行了比较。
初级保健医生将有认知、营养、行为、情绪或行动能力问题的老年人转介过来。151名参与者（平均年龄82.2岁，74.8%为女性）被纳入一项伪聚类随机试验，对主要结局进行6个月的随访。85名参与者接受了新干预，66名接受常规护理。在干预组中，老年护士与初级保健医生和老年病医生合作，上门对患者进行老年评估和管理。采用混合线性模型，修正意向性分析聚焦于治疗组在功能能力（格罗宁根活动受限量表-3）和心理健康（心理健康分量表，医学结局研究[MOS]-20）方面的差异。
3个月后，治疗组显示出新干预措施具有显著优势。功能能力提高了2.2分（95%置信区间[CI]，0.3 - 4.2），幸福感提高了5.8分（95%CI，0.1 - 11.4）。6个月后，幸福感的有利影响增加（9.1；95%CI，2.4 - 15.9），但对功能能力的影响不再显著（1.6；95%CI，-0.7至3.9）。
这种基于问题的老年干预措施改善了弱势老年人的功能能力和心理健康。基于问题的干预措施可以提高对这一人群的初级保健效果。
