Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
Physiotherapy Outpatients Department, Dynamic Health, Cambridgeshire Community Services NHS Trust, Huntingdon, United Kingdom.
J Am Geriatr Soc. 2019 Sep;67(9):1960-1969. doi: 10.1111/jgs.16048. Epub 2019 Jul 27.
To review the evidence evaluating the effectiveness of informal caregiver interventions to facilitate the recovery of older people discharged from the hospital.
Systematic review and meta-analysis.
Hospital and community.
Published and unpublished randomized and nonrandomized controlled trials assessing the effectiveness of informal caregiver interventions to support the recovery of older people discharged from the hospital were identified (to March 2019). The primary outcome was patient health-related quality of life (HRQOL). Secondary outcomes included patient function, caregiver burden, caregiver HRQOL, psychological distress, adverse events, and health resource use. Studies were critically appraised and meta-analyzed.
Adults who had been admitted to the hospital.
A total of 23 studies were eligible (4695 participants). The indication for hospital admission was stroke in 21 trials (91%). Interventions consisted of training and/or skills-based programs, with or without home visits/telephone follow-up. Caregiver interventions for patients following stroke may provide no benefit for patient HRQOL at 12 months (standardized mean difference = .29; 95% confidence interval = -.12 to .69; low-quality evidence). Caregiver interventions demonstrated benefit for caregiver burden and both patient and caregiver anxiety at 12 months. No consistent effect was found on functional outcomes, depression, HRQOL, adverse events, or health resource use measures.
Informal caregivers who receive training to facilitate the recovery of older people discharged from the hospital following stroke may have a lower burden and reduced anxiety at 12 months compared with those who do not. However, the evidence was moderate to low quality. Further study is warranted to explore whether caregiver interventions can be modified for nonstroke populations such as those with hip fracture. J Am Geriatr Soc 67:1960-1969, 2019.
回顾评估非专业护理人员干预措施对促进出院老年患者康复效果的证据。
系统评价和荟萃分析。
医院和社区。
检索并纳入（截至 2019 年 3 月）评估非专业护理人员干预措施对支持出院老年患者康复效果的已发表和未发表的随机和非随机对照试验。主要结局为患者健康相关生活质量（HRQOL）。次要结局包括患者功能、护理人员负担、护理人员 HRQOL、心理困扰、不良事件和卫生资源利用。对研究进行严格评价和荟萃分析。
曾住院的成年人。
共有 23 项研究符合条件（4695 名参与者）。21 项试验（91%）的入院指征为中风。干预措施包括培训和/或技能为基础的方案，有或没有家庭访视/电话随访。针对中风后患者的护理人员干预措施在 12 个月时对患者 HRQOL 可能没有益处（标准化均数差=0.29；95%置信区间=-.12 至.69；低质量证据）。护理人员干预措施在 12 个月时对护理人员负担以及患者和护理人员焦虑有获益。但未发现对功能结局、抑郁、HRQOL、不良事件或卫生资源利用指标有一致影响。
与未接受培训的护理人员相比，接受培训以促进出院后中风老年患者康复的非专业护理人员在 12 个月时可能负担较低，焦虑程度较低。但证据质量为中到低。需要进一步研究以探讨护理人员干预措施是否可以针对非中风人群（如髋部骨折患者）进行修改。
美国老年医学会 67:1960-1969, 2019.
