Division of Health Sciences, University of South Australia, North Terrace, Adelaide, South Australia, Australia.
School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, Australia.
BMC Geriatr. 2019 Aug 8;19(1):217. doi: 10.1186/s12877-019-1210-3.
Interventions that enable people to remain in their own home as they age are of interest to stakeholders, yet detailed information on effective interventions is scarce. Our objective was to systematically search and synthesise evidence for the effectiveness of community-based, aged care interventions in delaying or avoiding admission to residential aged care.
Nine databases were searched from January 2000 to February 2018 for English publications. Reference lists of relevant publications were searched. The databases yielded 55,221 citations and 50 citations were gleaned from other sources. Where there was sufficient homogeneity of study design, population, intervention and measures, meta-analyses were performed. Studies were grouped by the type of intervention: complex multifactorial interventions, minimal/single focus interventions, restorative programs, or by the target population (e.g. participants with dementia).
Data from 31 randomised controlled trials (32 articles) that met our inclusion criteria were extracted and analysed. Compared to controls, complex multifactorial interventions in community aged care significantly improved older adults' ability to remain living at home (risk difference - 0.02; 95% CI -0.03, - 0.00; p = 0.04). Commonalities in the 13 studies with complex interventions were the use of comprehensive assessment, regular reviews, case management, care planning, referrals to additional services, individualised interventions, frequent client contact if required, and liaison with General Practitioners. Complex interventions did not have a significantly different effect on mortality. Single focus interventions did not show a significant effect in reducing residential aged care admissions (risk difference 0, 95% CI -0.01, 0.01; p = 0.71), nor for mortality or quality of life. Subgroup analysis of complex interventions for people with dementia showed significant risk reduction for residential aged care admissions (RD -0.05; 95% CI -0.09, -0.01; p = 0.02). Compared to controls, only interventions targeting participants with dementia had a significant effect on improving quality of life (SMD 3.38, 95% CI 3.02, 3.74; p < 0.000001).
Where the goal is to avoid residential aged care admission for people with or without dementia, there is evidence for multifactorial, individualised community programs. The evidence suggests these interventions do not result in greater mortality and hence are safe. Minimal, single focus interventions will not achieve the targeted outcomes.
PROSPERO Registration CRD42016050086 .
让人们在年老时能够留在自己家中的干预措施引起了利益相关者的关注，但关于有效干预措施的详细信息却很少。我们的目的是系统地搜索和综合社区为基础的老年护理干预措施在延迟或避免入住养老院方面的有效性证据。
从 2000 年 1 月到 2018 年 2 月，我们在 9 个数据库中搜索英文出版物。还检索了相关出版物的参考文献列表。这些数据库产生了 55,221 条引文，从其他来源获得了 50 条引文。如果研究设计、人群、干预措施和措施具有足够的同质性，则进行荟萃分析。研究按干预措施的类型进行分组：复杂的多因素干预、单一焦点的最小干预、恢复性计划，或按目标人群（例如患有痴呆症的参与者）进行分组。
从符合纳入标准的 31 项随机对照试验（32 篇文章）中提取和分析数据。与对照组相比，社区老年护理中的复杂多因素干预显著提高了老年人居家生活的能力（风险差异-0.02；95%CI-0.03，-0.00；p=0.04）。13 项具有复杂干预措施的研究有共同特点，即使用全面评估、定期审查、病例管理、护理计划、转介给其他服务、个性化干预、根据需要经常与客户联系以及与全科医生联系。复杂干预措施对死亡率没有显著影响。单一焦点干预对减少养老院入住率没有显著效果（风险差异 0，95%CI 0.01，0.01；p=0.71），也没有对死亡率或生活质量产生影响。痴呆症患者复杂干预措施的亚组分析显示，养老院入住率显著降低（RD-0.05；95%CI-0.09，-0.01；p=0.02）。与对照组相比，只有针对痴呆症患者的干预措施对提高生活质量有显著影响（SMD 3.38，95%CI 3.02，3.74；p<0.000001）。
如果目标是避免有或没有痴呆症的人入住养老院，那么有证据表明多因素、个体化的社区计划是有效的。有证据表明，这些干预措施不会导致更高的死亡率，因此是安全的。最小的、单一焦点的干预措施不会达到预期的效果。
PROSPERO 注册 CRD42016050086 。
