Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
J Am Geriatr Soc. 2013 Aug;61(8):1399-409. doi: 10.1111/jgs.12372. Epub 2013 Jul 19.
In response to the need for an evidence-based review of factors within long-term care settings that affect the quality of care, this review compared characteristics of nursing homes and other residential long-term care settings for people with dementia and their informal family caregivers with respect to health and psychosocial outcomes.
Databases were searched for literature published between 1990 and March 2012 that met review criteria, including that at least 80% of the subject population had dementia.
Fourteen articles meeting review criteria that were of at least fair quality were found: four prospective cohort studies, nine randomized controlled trials (RCTs), and one nonrandomized controlled trial. Overall, low or insufficient strength of evidence was found regarding the effect of most organizational characteristics, structures, and processes of care on health and psychosocial outcomes for people with dementia and no evidence for informal caregivers. Findings of moderate strength of evidence indicate that pleasant sensory stimulation reduces agitation for people with dementia. Also, although the strength of evidence is low, protocols for individualized care and to improve function result in better outcomes for these individuals. Finally, outcomes do not differ between nursing homes and residential care or assisted living settings for people with dementia except when medical care is indicated.
Given the paucity of high-quality studies in this area, additional research is needed to develop a sufficient evidence base to support consumer selection, practice, and policy regarding the best settings and characteristics of settings for residential long-term care of people with dementia.
为了满足对长期护理环境中影响护理质量的因素进行循证评估的需求，本研究比较了患有痴呆症的患者及其非正规家庭护理人员的疗养院和其他长期居住护理环境的特征，评估其健康和心理社会结局。
本研究检索了 1990 年至 2012 年 3 月期间发表的符合审查标准的文献，这些文献至少有 80%的研究对象患有痴呆症。
本研究发现了 14 篇符合审查标准的文献，这些文献的质量至少为中等：4 项前瞻性队列研究、9 项随机对照试验（RCT）和 1 项非随机对照试验。总的来说，关于大多数组织特征、护理结构和过程对痴呆症患者的健康和心理社会结局的影响，证据的强度较低或不足，而针对非正规护理人员的证据则不存在。有中等强度证据表明，愉悦的感官刺激可减少痴呆症患者的躁动。此外，尽管证据强度较低，但个体化护理和改善功能的方案可改善这些患者的结局。最后，患有痴呆症的患者在疗养院和居住护理或辅助生活环境中的结局并无差异，除非需要医疗护理。
鉴于该领域高质量研究的缺乏，需要开展更多的研究来建立一个足够的证据基础，以支持针对居住长期护理的最佳环境和环境特征的消费者选择、实践和政策，为患有痴呆症的患者提供服务。
