Streater Amy, Coleston-Shields Donna Maria, Yates Jennifer, Stanyon Miriam, Orrell Martin
Research and Development, North East London NHS Foundation Trust, Ilford.
Institute of Mental Health, University of Nottingham, Nottingham, UK.
Clin Interv Aging. 2017 Oct 3;12:1589-1603. doi: 10.2147/CIA.S142341. eCollection 2017.
Research on crisis teams for older adults with dementia is limited. This scoping review aimed to 1) conduct a systematic literature review reporting on the effectiveness of crisis interventions for older people with dementia and 2) conduct a scoping survey with dementia crisis teams mapping services across England to understand operational procedures and identify what is currently occurring in practice.
For the systematic literature review, included studies were graded using the Critical Appraisal Skills Programme checklist. For the scoping survey, Trusts across England were contacted and relevant services were identified that work with people with dementia experiencing a mental health crisis.
The systematic literature review demonstrated limited evidence in support of crisis teams reducing the rate of hospital admissions, and despite the increase in number of studies, methodological limitations remain. For the scoping review, only half (51.8%) of the teams had a care pathway to manage crises and the primary need for referral was behavioral or psychological factors.
Evidence in the literature for the effectiveness of crisis teams for older adults with dementia remains limited. Being mainly cohort designs can make it difficult to evaluate the effectiveness of the intervention. In practice, it appears that the pathway for care managing crisis for people with dementia varies widely across services in England. There was a wide range of names given to the provision of teams managing crisis for people with dementia, which may reflect the differences in the setup and procedures of the service. To provide evidence on crisis intervention teams, a comprehensive protocol is required to deliver a standardized care pathway and measurable intervention as part of a large-scale evaluation of effectiveness.
针对老年痴呆症患者危机应对团队的研究有限。本综述旨在:1)对关于老年痴呆症患者危机干预效果的研究进行系统文献综述;2)对英格兰各地的痴呆症危机应对团队开展范围界定调查,绘制服务地图,以了解其运作程序,并确定当前实践中的情况。
对于系统文献综述,采用批判性评估技能计划清单对纳入研究进行分级。对于范围界定调查,联系了英格兰各地的信托机构,并确定了与经历心理健康危机的痴呆症患者合作的相关服务。
系统文献综述显示,支持危机应对团队降低住院率的证据有限,而且尽管研究数量有所增加,但方法学上的局限性仍然存在。在范围界定综述中,只有一半(51.8%)的团队有管理危机的护理路径,转诊的主要需求是行为或心理因素。
关于痴呆症老年患者危机应对团队有效性的文献证据仍然有限。由于主要是队列研究设计,难以评估干预措施的有效性。在实践中,英格兰各地针对痴呆症患者危机管理的护理路径差异很大。为痴呆症患者提供危机管理团队的服务有各种各样的名称,这可能反映了服务设置和程序的差异。为了提供有关危机干预团队的证据,需要一个全面的方案来提供标准化的护理路径和可衡量的干预措施,作为大规模有效性评估的一部分。