Bajraktari Saranda, Sandlund Marlene, Zingmark Magnus
Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden.
Arch Public Health. 2020 Oct 14;78:97. doi: 10.1186/s13690-020-00480-5. eCollection 2020.
Despite the promising evidence of health-promoting and preventive interventions for maintaining health among older people, not all interventions can be implemented due to limited resources. Due to the variation of content in the interventions and the breadth of outcomes used to evaluate effects in such interventions, comparisons are difficult and the choice of which interventions to implement is challenging. Therefore, more information, beyond effects, is needed to guide decision-makers. The aim of this review was to investigate, to what degree factors important for decision-making have been reported in the existing health-promoting and preventive interventions literature for community-dwelling older people in the Nordic countries.
This review was guided by the PRISMA-ScR checklist (Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews), the methodological steps for scoping reviews described in the Arksey and O'Malley's framework, and the Medical Research Council's (MRC) guidance on complex interventions. Eligible studies for inclusion were randomised controlled trials (RCTs) concerning health promotion or primary prevention for community-dwelling older people implemented in the Nordic countries. Additionally, all included RCTs were searched for related papers that were reporting on additional factors. Eligible studies were searched in seven databases: PubMed, SCOPUS, CINAHL, Academic Search Elite, PsycINFO, SocINDEX, and SPORTDiscus.
Eighty-two studies met the inclusion criteria (twenty-seven unique studies and fifty-five related studies). Twelve studies focused on fall prevention, eleven had a health-promoting approach, and four studies focused on preventing disability. All interventions, besides one, reported positive effects on at least one health outcome. Three studies reported data on cost-effectiveness, three on experiences of participants and two conducted feasibility studies. Only one intervention, reported information on all seven factors.
All identified studies on health-promoting and preventive interventions for older people evaluated in the Nordic countries report positive effects although the magnitude of effects and number of follow-ups differed substantially. Overall, there was a general lack of studies on feasibility, cost-effectiveness, and experiences of participants, thus, limiting the basis for decision making. Considering all reported factors, promising candidates to be recommended for implementation in a Nordic municipality context are 'Senior meetings', 'preventive home visits' and 'exercise interventions' on its own or combined with other components.
尽管有证据表明促进健康和预防干预措施对老年人维持健康有积极作用，但由于资源有限，并非所有干预措施都能得以实施。由于干预措施内容各异，且用于评估此类干预效果的结果范围广泛，因此难以进行比较，选择实施何种干预措施具有挑战性。因此，除了效果之外，还需要更多信息来指导决策者。本综述的目的是调查在北欧国家针对社区居住老年人的现有促进健康和预防干预措施文献中，对决策重要的因素在多大程度上得到了报道。
本综述以PRISMA-ScR清单（系统评价和Meta分析扩展的范围综述的首选报告项目）、Arksey和O'Malley框架中描述的范围综述方法步骤以及医学研究理事会（MRC）关于复杂干预措施的指南为指导。纳入的合格研究为在北欧国家实施的针对社区居住老年人的健康促进或一级预防的随机对照试验（RCT）。此外，对所有纳入的RCT进行检索，查找报告其他因素的相关论文。在七个数据库中检索合格研究：PubMed、SCOPUS、CINAHL、Academic Search Elite、PsycINFO、SocINDEX和SPORTDiscus。
82项研究符合纳入标准（27项独立研究和55项相关研究）。12项研究关注跌倒预防，11项采用促进健康的方法，4项研究关注预防残疾。除一项干预措施外，所有干预措施均报告了对至少一项健康结果的积极影响。3项研究报告了成本效益数据，3项报告了参与者的体验，2项进行了可行性研究。只有一项干预措施报告了所有七个因素的信息。
在北欧国家评估的所有已确定的针对老年人的促进健康和预防干预措施研究均报告了积极影响，尽管效果大小和随访次数差异很大。总体而言，普遍缺乏关于可行性、成本效益和参与者体验的研究，因此限制了决策的依据。考虑到所有报告的因素，在北欧城市环境中推荐实施的有前景的候选措施是“老年人会议”、“预防性家访”以及单独或与其他组成部分结合的“运动干预”。
