University Medicine Greifswald, Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, Greifswald, Germany.
Maturitas. 2012 Oct;73(2):94-114. doi: 10.1016/j.maturitas.2012.06.010. Epub 2012 Jul 17.
Telemedicine is increasingly becoming a reality in medical care for the elderly. We performed a systematic literature review on telemedicine healthcare concepts for older patients. We included controlled studies in an ambulant setting that analyzed telemedicine interventions involving patients aged ≥60 years. 1585 articles matched the specified search criteria, thereof, 68 could be included in the review. Applications address an array of mostly frequent diseases, e.g. cardiovascular disease (N=37) or diabetes (N=18). The majority of patients is still living at home and is able to handle the telemedicine devices by themselves. In 59 of 68 articles (87%), the intervention can be categorized as monitoring. The largest proportion of telemedicine interventions consisted of measurements of vital signs combined with personal interaction between healthcare provider and patient (N=24), and concepts with only personal interaction (telephone or videoconferencing, N=14). The studies show predominantly positive results with a clear trend towards better results for "behavioral" endpoints, e.g. adherence to medication or diet, and self-efficacy compared to results for medical outcomes (e.g. blood pressure, or mortality), quality of life, and economic outcomes (e.g. costs or hospitalization). However, in 26 of 68 included studies, patients with characteristic limitations for older patients (e.g. cognitive and visual impairment, communication barriers, hearing problems) were excluded. A considerable number of projects use rather sophisticated technology (e.g. videoconferencing), limiting ready translation into routine care. Future research should focus on how to adapt systems to the individual needs and resources of elderly patients within the specific frameworks of the respective national healthcare systems.
远程医疗在老年医疗保健中越来越成为现实。我们对针对老年患者的远程医疗保健概念进行了系统的文献回顾。我们纳入了在流动环境中进行的、分析了涉及≥60 岁患者的远程医疗干预的对照研究。符合指定搜索标准的 1585 篇文章中，有 68 篇可以纳入综述。这些应用程序针对的是一系列常见疾病，如心血管疾病（N=37）或糖尿病（N=18）。大多数患者仍居住在家中，并且能够自行使用远程医疗设备。在 68 篇文章中的 59 篇（87%）中，干预措施可以归类为监测。远程医疗干预的最大比例包括生命体征的测量以及医护人员与患者之间的个人互动（N=24），以及仅具有个人互动的概念（电话或视频会议，N=14）。这些研究主要显示出积极的结果，并且对于“行为”终点（例如，药物或饮食依从性以及自我效能），与医疗结果（例如血压或死亡率）、生活质量和经济结果（例如成本或住院治疗）相比，具有明显的改善趋势。但是，在纳入的 68 项研究中，有 26 项研究排除了具有老年患者典型限制的患者（例如认知和视力障碍、沟通障碍、听力问题）。相当多的项目使用了相当复杂的技术（例如视频会议），限制了将其直接转化为常规护理。未来的研究应侧重于如何根据特定国家医疗保健系统的个别患者的需求和资源来调整系统。
