Hartley Peter, Gibbins Nathalie, Saunders Amanda, Alexander Kerry, Conroy Eimear, Dixon Rebecca, Lang Joseph, Luckett Jasmine, Luddington Tim, Romero-Ortuno Roman
Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
Department of Medicine for the Elderly, Cambridge University Hospitals NHS Foundation Trust, Box 135, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
Age Ageing. 2017 Jul 1;46(4):559-567. doi: 10.1093/ageing/afx007.
in hospitalised older adults, cognitive impairments are common and may be associated with functional outcomes. Our aim was to systematically review this association.
we systematically searched MEDLINE, CINAHL, AMED and PsycINFO from inception to April 2016. Non-English language studies were filtered out at search stage. All types of studies were considered for inclusion except reviews, conference abstracts, dissertations and case studies. Population: community-dwelling or institutionalised older adults aged 65 years or more, who are acutely hospitalised and have information on history of dementia and/or cognitive scores on admission. Setting: acute hospital (excluding critical care and subacute or intermediate care). Outcome of interest: change in a measure of physical function or disability between pre-admission or admission, and discharge or post-discharge. This review was registered on PROSPERO (CRD42016035978).
the search returned 5,988 unique articles, of which 34 met inclusion criteria. All studies were observational, with 30 prospective and 4 retrospective from 14 countries, recruiting from general medicine (n = 11), geriatric medicine (n = 11) and mixed (n = 12) wards. Twenty-six studies (54,637 participants) were suitable for the quantitative synthesis. The meta-analysis suggested that cognitive impairment was associated with functional decline in hospitalised older adults (risk ratio (RR): 1.64; 95% confidence interval (CI): 1.45-1.86; P < 0.01). Results were similar in subanalyses focusing on diagnosis of dementia (RR: 1.36; 95% CI: 1.05-1.76; P = 0.02; n= 2,248) or delirium (RR: 1.55; 95% CI: 1.31-1.83; P < 0.01; n= 1,677).
cognitive impairments seem associated with functional decline in hospitalised older people. Causality cannot be inferred, and limitations include low quality of studies and possible confounding.
在住院的老年人中，认知障碍很常见，并且可能与功能结局相关。我们的目的是系统评价这种关联。
我们系统检索了从数据库建立至2016年4月的MEDLINE、CINAHL、AMED和PsycINFO。在检索阶段排除了非英语语言研究。除综述、会议摘要、学位论文和病例研究外，所有类型的研究均考虑纳入。研究对象：年龄在65岁及以上的社区居住或机构养老的老年人，他们因急性病住院，且有痴呆病史和/或入院时认知评分的信息。研究地点：急性医院（不包括重症监护以及亚急性或中间护理）。感兴趣的结局：入院前或入院时与出院时或出院后身体功能或残疾测量指标的变化。本综述已在国际前瞻性系统评价注册库（PROSPERO）注册（注册号：CRD42016035978）。
检索共获得5988篇独特的文章，其中34篇符合纳入标准。所有研究均为观察性研究，来自14个国家，包括30项前瞻性研究和4项回顾性研究，研究对象来自普通内科病房（n = 11）、老年医学病房（n = 11）和混合病房（n = 12）。26项研究（54637名参与者）适合进行定量综合分析。荟萃分析表明，认知障碍与住院老年人的功能下降相关（风险比（RR）：1.64；95%置信区间（CI）：1.45 - 1.86；P < 0.01）。在侧重于痴呆诊断（RR：1.36；95% CI：1.05 - 1.76；P = 0.02；n = 2248）或谵妄（RR：1.55；95% CI：1.31 - 1.83；P < 0.01；n = 1677）的亚组分析中，结果相似。
认知障碍似乎与住院老年人的功能下降相关。无法推断因果关系，局限性包括研究质量低和可能存在混杂因素。
