复杂干预措施对支持社区居住的老年人群自我护理的效果：系统评价和荟萃分析。

The effect of complex interventions on supporting self-care among community-dwelling older adults: a systematic review and meta-analysis.

机构信息

School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.

出版信息

Age Ageing. 2018 Mar 1;47(2):185-193. doi: 10.1093/ageing/afx151.

DOI:10.1093/ageing/afx151

PMID:28927235

Abstract

BACKGROUND

self-care is critical to enable community-dwelling older adults to live independently. Complex interventions have emerged as a strategy to support self-care, but their effectiveness is unknown. Our objective was to review systematically their effectiveness on both positive (increased scores in self-rated health, Activities of Daily Living, Instrumental Activities of Daily Living, quality of life) and negative aspects (increased incidence of falls, fear of falling, hospital and nursing home admission, increased depression score), and to determine which intervention components explain the observed effects.

METHODS

CINAHL, MEDLINE, British Nursing Index, PsycInfo and Cochrane CENTRAL were searched from January 2006 to October 2016. Randomised controlled trials providing at least two of these components: individual assessment, care planning or provision of information were reviewed. Outcomes were pooled by random-effects meta-analysis.

RESULTS

twenty-two trials with 14,364 participants were included with a low risk of bias. Pooled effects showed significant benefits on positive aspects including self-rated health [standardised mean difference (SMD) 0.09, 95% confidence interval (CI) 0.01-0.17] and the mental subscale of quality of life (SMD 0.44, 95% CI 0.09-0.80) as well as on the negative aspect of incidence of falls [odds ratio (OR) 0.60, 95% CI 0.46-0.79]. There was no significant improvement in ADL, IADL, overall quality of life, fear of falling, reduction in health service utilisation or depression levels. Meta-regression and subgroup analysis did not identify any specific component or characteristic in complex interventions which explained these effects.

CONCLUSION

based on current evidence, supporting self-care in community-dwelling older adults using complex interventions effectively increases self-rated health, reduces the occurrence of falls and improves the mental subscale of quality of life.

摘要

背景

自我护理对于使社区居住的老年人能够独立生活至关重要。复杂干预措施已成为支持自我护理的一种策略，但它们的效果尚不清楚。我们的目的是系统地审查它们在积极方面（自我评估的健康评分、日常生活活动、工具性日常生活活动、生活质量增加）和消极方面（跌倒发生率增加、跌倒恐惧、住院和养老院入院、抑郁评分增加）的有效性，并确定哪些干预成分可以解释观察到的效果。

方法

从 2006 年 1 月至 2016 年 10 月，我们在 CINAHL、MEDLINE、英国护理索引、PsycInfo 和 Cochrane CENTRAL 上进行了检索。审查了提供至少以下两个组成部分的随机对照试验：个体评估、护理计划或信息提供。通过随机效应荟萃分析汇总结果。

结果

共纳入 22 项试验，涉及 14364 名参与者，偏倚风险较低。汇总效应显示，在积极方面有显著获益，包括自我评估的健康[标准化均数差（SMD）0.09，95%置信区间（CI）0.01-0.17]和生活质量的心理子量表（SMD 0.44，95% CI 0.09-0.80），以及跌倒发生率的负面方面[比值比（OR）0.60，95% CI 0.46-0.79]。日常生活活动、工具性日常生活活动、总体生活质量、跌倒恐惧、卫生服务利用减少或抑郁水平均无显著改善。元回归和亚组分析未发现复杂干预措施中的任何特定组成部分或特征可以解释这些效果。