针对社区居住的轻度或脆弱前期老年人的健康促进干预措施：一项系统综述和荟萃分析。
Health promotion interventions for community-dwelling older people with mild or pre-frailty: a systematic review and meta-analysis.
作者信息
Frost Rachael, Belk Celia, Jovicic Ana, Ricciardi Federico, Kharicha Kalpa, Gardner Benjamin, Iliffe Steve, Goodman Claire, Manthorpe Jill, Drennan Vari M, Walters Kate
机构信息
Department of Primary Care and Population Health, University College London, London, UK.
Department of Statistical Science, University College London, London, UK.
出版信息
BMC Geriatr. 2017 Jul 20;17(1):157. doi: 10.1186/s12877-017-0547-8.
BACKGROUND
Mild or pre-frailty is common and associated with increased risks of hospitalisation, functional decline, moves to long-term care, and death. Little is known about the effectiveness of health promotion in reducing these risks. This systematic review aimed to synthesise randomised controlled trials (RCTs) evaluating home and community-based health promotion interventions for older people with mild/pre-frailty.
METHODS
We searched 20 bibliographic databases and 3 trials registers (January 1990 - May 2016) using mild/pre-frailty and associated terms. We included randomised controlled and crossover trials of health promotion interventions for community-dwelling older people (65+ years) with mild/pre-frailty and excluded studies focussing on populations in hospital, long term care facilities or with a specific condition. Risk of bias was assessed by two reviewers using the Cochrane Risk of Bias tool. We pooled study results using standardised mean differences (SMD) where possible and used narrative synthesis where insufficient outcome data were available.
RESULTS
We included 10 articles reporting on seven trials (total n = 506 participants) and included five trials in a meta-analysis. Studies were predominantly small, of limited quality and six studies tested group exercise alone. One study additionally investigated a nutrition and exercise intervention and one evaluated telemonitoring. Interventions of exercise in groups showed mixed effects on functioning (no effects on self-reported functioning SMD 0.19 (95% CI -0.57 to 0.95) n = 3 studies; positive effects on performance-based functioning SMD 0.37 (95% CI 0.07 to 0.68) n = 3 studies). No studies assessed moves to long-term care or hospitalisations.
CONCLUSIONS
Currently the evidence base is of insufficient size, quality and breadth to recommend specific health promotion interventions for older people with mild or pre- frailty. High quality studies of rigorously developed interventions are needed.
PROSPERO REGISTRATION
CRD42014010370 (Review 2).
背景
轻度衰弱或衰弱前期很常见，且与住院风险增加、功能衰退、转入长期护理机构以及死亡风险增加相关。关于健康促进在降低这些风险方面的有效性，人们了解甚少。本系统评价旨在综合评估针对轻度/衰弱前期老年人的家庭和社区健康促进干预措施的随机对照试验（RCT）。
方法
我们使用轻度/衰弱前期及相关术语检索了20个文献数据库和3个试验注册库（1990年1月至2016年5月）。我们纳入了针对社区居住的轻度/衰弱前期老年人（65岁及以上）的健康促进干预措施的随机对照试验和交叉试验，并排除了针对住院患者、长期护理机构患者或患有特定疾病人群的研究。由两名评价员使用Cochrane偏倚风险工具评估偏倚风险。我们尽可能使用标准化均数差（SMD）汇总研究结果，在结局数据不足时采用叙述性综合分析。
结果
我们纳入了10篇报告7项试验的文章（共506名参与者），并将5项试验纳入荟萃分析。研究大多规模较小，质量有限，6项研究仅测试了团体运动。一项研究还调查了营养和运动干预措施，一项评估了远程监测。团体运动干预对功能的影响不一（对自我报告功能无影响，SMD 0.19（95%CI -0.57至0.95），n = 3项研究；对基于表现的功能有积极影响，SMD 0.37（95%CI 0.07至0.68），n = 3项研究）。没有研究评估转入长期护理机构或住院情况。
结论
目前，证据基础在规模、质量和广度上不足以推荐针对轻度或衰弱前期老年人的特定健康促进干预措施。需要开展关于严格制定的干预措施的高质量研究。
PROSPERO注册编号：CRD42014010370（综述2）
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