养老机构中痴呆的神经精神症状的非药物干预措施：伞式综述。
Non-pharmacological interventions for neuropsychiatric symptoms of dementia in residential aged care settings: An umbrella review.
机构信息
School of Psychology, University of New South Wales, Sydney, NSW, Australia; Neuroscience Research Australia, 139 Baker Street, Randwick, Sydney, NSW, Australia.
Dementia Centre for Research Collaboration, School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia.
出版信息
Int J Nurs Stud. 2022 Apr;128:104187. doi: 10.1016/j.ijnurstu.2022.104187. Epub 2022 Jan 29.
BACKGROUND
Prevalence of neuropsychiatric symptoms amongst people living with dementia in residential aged care is high. Their presence is associated with poorer quality of life for residents and higher burden of care for staff. Existing reviews have not focused on the evaluation of efficacy of non-pharmacological interventions in specific population settings (community vs. residential aged care).
OBJECTIVES
To determine the efficacy of non-pharmacological interventions to manage neuropsychiatric symptoms of dementia in residential aged care settings.
DESIGN
An umbrella review was conducted.
DATA SOURCES
PubMed/Medline, Embase, Cochrane Library and Web of Science were searched for eligible reviews in December 2019, February 2020 and June 2021.
METHODS
Two authors independently screened titles and abstracts, and assessed full-text reviews for eligibility. The quality of reviews was appraised with 'AMSTAR-2: A Measurement tool to assess systematic reviews'. Narrative summaries grouped findings by intervention domains.
RESULTS
From 1362 systematic reviews identified, 26 met the inclusion criteria. Of these, 10 focused on person tailored interventions, six on sensory stimulation interventions, three on environmental interventions, three on exercise interventions, and four on multiple intervention types. Quality ratings identified reviews to be of mostly moderate quality (73%). The majority or reviews reported positive results but not all were statistically significant. Tailored interventions that included music and social elements appeared to be most beneficial for depressive symptoms and mood. Furthermore, outcome measures and intervention protocols were highly heterogeneous across interventions.
CONCLUSIONS
The findings of this umbrella review suggest that combining different types of interventions and tailoring them to the personal experiences of the resident is recommended. A more standardised approach for outcome measures used is vital to assess efficacy and allow comparison of future non-pharmacological interventions.
背景
在养老院居住的痴呆症患者中，神经精神症状的患病率很高。这些症状的存在与居民生活质量下降和护理人员负担加重有关。现有的综述并未关注特定人群环境（社区与养老院）中，非药物干预措施的疗效评估。
目的
确定非药物干预措施在养老院环境中管理痴呆症神经精神症状的疗效。
设计
进行了伞式综述。
资料来源
2019 年 12 月、2020 年 2 月和 2021 年 6 月，通过 PubMed/Medline、Embase、Cochrane 图书馆和 Web of Science 检索了合格的综述。
方法
两名作者独立筛选标题和摘要，并评估了综述的全文是否符合纳入标准。使用“AMSTAR-2：评估系统评价的测量工具”评估综述的质量。按干预领域对发现进行分组叙述总结。
结果
从 1362 篇系统综述中，有 26 篇符合纳入标准。其中，10 篇侧重于个性化干预，6 篇侧重于感官刺激干预，3 篇侧重于环境干预，3 篇侧重于运动干预，4 篇侧重于多种干预类型。质量评估将综述确定为中等偏高质量（73%）。大多数综述报告了积极的结果，但并非所有结果均具有统计学意义。包含音乐和社会元素的个性化干预措施似乎对抑郁症状和情绪最有益。此外，干预措施的结果测量和干预方案在不同干预措施之间存在高度异质性。
结论
本伞式综述的结果表明，建议将不同类型的干预措施结合起来，并根据居民的个人经验进行调整。对于使用的结果测量，采用更标准化的方法对于评估疗效和允许比较未来的非药物干预措施至关重要。
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