PhD, CNS, Lecturer, Nursing Department, Faculty of Health Science, Universitas 'Aisyiyah, Yogyakarta, Indonesia.
PhD, RN, Assistant Professor, School of Nursing, Chang Gung University of Science and Technology, Taiwan, ROC.
J Nurs Res. 2020 Jun;28(3):e97. doi: 10.1097/jnr.0000000000000371.
Hip fractures in persons with cognitive impairments represent a major public health issue in older populations that often results in poor health-related quality of life (HRQoL).
The aim of this systemic review was to examine the changes in HRQoL in older, cognitively impaired patients with hip fracture who had received surgical treatment.
A literature search of PubMed, Scopus, MEDLINE, PsycINFO, and CINAHL (EBSCO) databases was conducted for studies published up to July 2018 that addressed the issue of HRQoL in cognitively impaired patients with hip fracture after surgery. Studies that met the following criteria were included: Patients with hip fracture were over 60 years old and had cognitive impairment or dementia, patients had undergone hip fracture repair surgery, HRQoL was determined using standardized questionnaires, a descriptive or interventional methodology was used, and the full-text article was available in English.
A primary search of databases yielded 1,528 studies, 621 duplicates were removed, and the remaining 907 abstracts were screened. Thirty-four full-text articles were deemed relevant for full review; of these, 10 articles met the criteria for inclusion in the review. Cognitive impairment was found to impact negatively on the patients' HRQoL after hip fracture surgery (n = 809). Severity of cognitive impairment was correlated with deterioration in HRQoL after hospital discharge. When compared with prefracture measures of HRQoL, the greatest deterioration in HRQoL postsurgery occurred during the first 4 months after discharge. Impacts on HRQoL for patients with cognitive impairment at later time points differed depending on type of hip fracture and type of surgical treatment. However, for most of the patients, HRQoL remained relatively unchanged at 6, 12, and 24 months postdischarge.
We recommend nursing care interventions for older persons with cognitive impairment be initiated immediately after surgery for hip fracture to prevent a significant decline in HRQoL. Further examination of interventions that are effective in maintaining HRQoL for these patients such as interdisciplinary care is necessary. In addition, the influences of hip fracture type and surgical approach on changes in HRQoL suggest a need for further investigations to determine what contributed to the observed inconsistencies in the outcomes.
认知障碍患者的髋部骨折是老年人群中的一个主要公共卫生问题，常导致健康相关生活质量（HRQoL）下降。
本系统评价旨在研究接受手术治疗的老年认知障碍髋部骨折患者的 HRQoL 变化。
对 PubMed、Scopus、MEDLINE、PsycINFO 和 CINAHL（EBSCO）数据库进行文献检索，检索时间截至 2018 年 7 月，以解决手术后认知障碍髋部骨折患者的 HRQoL 问题。纳入的研究符合以下标准：患者年龄超过 60 岁且存在认知障碍或痴呆，患者接受了髋部骨折修复手术，使用标准化问卷确定 HRQoL，采用描述性或干预性方法，且全文以英文发表。
数据库的初次检索得到 1528 项研究，剔除 621 项重复文献，筛选出 907 篇摘要。34 篇全文文章被认为与全文审查相关；其中 10 篇文章符合纳入标准。认知障碍会对髋部骨折手术后患者的 HRQoL 产生负面影响（n=809）。认知障碍的严重程度与出院后 HRQoL 的恶化相关。与骨折前的 HRQoL 测量相比，出院后 4 个月内 HRQoL 下降最明显。认知障碍患者在后期时间点的 HRQoL 受髋部骨折类型和手术治疗类型的影响不同。然而，对于大多数患者，出院后 6、12 和 24 个月时 HRQoL 相对保持不变。
我们建议对接受髋部骨折手术的老年认知障碍患者立即启动护理干预措施，以防止 HRQoL 显著下降。需要进一步研究能够维持这些患者 HRQoL 的干预措施，如跨学科护理。此外，髋部骨折类型和手术方式对 HRQoL 变化的影响表明需要进一步调查，以确定导致观察到的结果不一致的原因。
