School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Frankston, Vic., Australia.
Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Vic., Australia.
Health Soc Care Community. 2020 Sep;28(5):1408-1429. doi: 10.1111/hsc.12984. Epub 2020 Mar 28.
Older people with dementia more frequently experience episodes of hospital care, transferal to nursing home and adverse events when they are in these environments. This study synthesised the available evidence examining non-pharmacological interventions to prevent hospital or nursing home admissions for community-dwelling older people with dementia. Seven health science databases of all dates were searched up to 2 December 2019. Randomised controlled trials and comparative studies investigating non-pharmacological interventions for older people with dementia who lived in the community were included. Meta-analyses using a random-effect model of randomised controlled trials were used to assess the effectiveness of interventions using measures taken as close to 12 months into follow-up as reported. Outcomes were risk and rate of hospital and nursing home admissions. Risk ratio (RR) or rate ratios (RaR) with 95% confidence interval were used to pool results for hospital and nursing home admission outcomes. Sensitivity analyses were conducted to include pooling of results from non-randomised trails. Twenty studies were included in the review. Community care coordination reduced rate of nursing home admissions [(2 studies, n = 303 people with dementia and 86 patient-caregiver dyads), pooled RaR = 0.66, 95% CI (0.45, 0.97), I = 0%, p = .45]. Single interventions of psychoeducation and multifactorial interventions comprising of treatment and assessment clinics indicated no effect on hospital or nursing home admissions. The preliminary evidence of community care coordination on reducing the rate of nursing home admissions may be considered with caution when planning for community services or care for older people living with dementia.
患有痴呆症的老年人在住院期间、转移到养老院期间以及在这些环境中更频繁地经历医院护理、转移到养老院和不良事件。本研究综合了现有证据，研究了预防社区居住的痴呆症老年人住院或入住养老院的非药物干预措施。截至 2019 年 12 月 2 日，检索了所有日期的 7 个健康科学数据库。纳入了针对居住在社区的痴呆症老年人的非药物干预措施的随机对照试验和比较研究。使用随机对照试验的随机效应模型进行荟萃分析，使用报告的随访接近 12 个月时采取的措施评估干预措施的有效性。结果是医院和养老院入院的风险和比率。使用风险比（RR）或比率比（RaR）和 95%置信区间来汇总医院和养老院入院结果。进行敏感性分析以纳入非随机试验的结果汇总。本综述共纳入 20 项研究。社区护理协调降低了养老院入院率[（2 项研究，n = 303 名痴呆症患者和 86 名患者-护理员对），汇总 RaR = 0.66，95%CI（0.45，0.97），I = 0%，p = 0.45]。单一的心理教育干预和包含治疗和评估诊所的多因素干预对医院或养老院入院无影响。在规划社区服务或照顾患有痴呆症的老年人时，应谨慎考虑社区护理协调在降低养老院入院率方面的初步证据。
