Ringer Thom, Hazzan Afeez Abiola, Agarwal Arnav, Mutsaers Adam, Papaioannou Alexandra
Geriatric Education and Research in Aging Sciences (GERAS), St. Peter's Hospital, 88 Maplewood Avenue, Hamilton, Ontario, L8M 1W9, Canada.
Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada.
Syst Rev. 2017 Mar 14;6(1):55. doi: 10.1186/s13643-017-0447-1.
Physical frailty is a prevalent syndrome in older adults that increases vulnerability for a range of adverse outcomes including increased dependency and death. Caregivers of older adults experience significant physical, emotional, and financial burden, which is associated with poor physical and mental health. While it is known that care recipients' dementia is associated with burden, the literature regarding the impact of physical frailty on burden has yet to be synthesized. We conducted a systematic review to assess the state of the evidence regarding the relationship between these two prominent concepts in the geriatric literature.
We used a structured search of databases to identify original English-language articles. Two researchers screened the titles and abstracts of all 1202 retrieved studies and then full-text versions of 265 retained studies. Screening was based on a priori inclusion criteria, which included discussion of physical frailty, caregiver burden, and a population of community-dwelling older adults without dementia. Nine included papers underwent data abstraction and critical appraisal using the Cochrane Risk of Bias Tool or the Newcastle-Ottawa Scale (for randomized controlled trials or cross-sectional studies, respectively). Heterogeneity of the included studies precluded meta-analysis.
Five publications had the same author and drew from the same population; these were treated as a single study. Three of our studies were of limited value since they did not include a validated measure of frailty. While caregivers of frail older adults experience burden, the scarce available evidence and lack of studies comparing this population with normative values does not allow conclusions to be drawn about the strength or nature of the relationship. Judging from excluded studies, the term "frailty" is often used without reference to a clear definition or is treated as synonymous with functional impairment or advanced age.
Our review suggests that caregivers of frail older adults experience burden and that the degree of burden may differ from that of other caregiver populations. The limited evidence does not allow conclusions to be drawn or to inform clinical practice. Further research is needed, given the salience of physical frailty and burden.
PROSPERO CRD42015019198.
身体虚弱是老年人中普遍存在的一种综合征，会增加一系列不良后果的易感性，包括依赖性增加和死亡。老年人的照料者会承受巨大的身体、情感和经济负担，这与身心健康状况不佳有关。虽然已知受照料者的痴呆症与负担有关，但关于身体虚弱对负担影响的文献尚未进行综合分析。我们进行了一项系统综述，以评估老年医学文献中这两个重要概念之间关系的证据状况。
我们使用结构化数据库搜索来识别英文原创文章。两名研究人员筛选了所有1202项检索到的研究的标题和摘要，然后筛选了265项保留研究的全文版本。筛选基于预先设定的纳入标准，包括对身体虚弱、照料者负担以及无痴呆症的社区居住老年人群体的讨论。九篇纳入论文分别使用Cochrane偏倚风险工具或纽卡斯尔-渥太华量表（分别用于随机对照试验或横断面研究）进行数据提取和批判性评价。纳入研究的异质性排除了进行荟萃分析的可能性。
五篇出版物由同一作者撰写且来自同一人群；这些被视为一项研究。我们的三项研究价值有限，因为它们没有包括经过验证的虚弱测量方法。虽然体弱老年人的照料者会承受负担，但现有证据稀少且缺乏将该人群与正常标准值进行比较的研究，因此无法就这种关系的强度或性质得出结论。从排除的研究来看，“虚弱”一词经常在没有明确界定的情况下使用，或者被视为功能障碍或高龄的同义词。
我们的综述表明，体弱老年人的照料者会承受负担，且负担程度可能与其他照料者群体不同。有限的证据无法得出结论或为临床实践提供参考。鉴于身体虚弱和负担问题的重要性，需要进一步开展研究。
PROSPERO CRD42015019198
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