Reich Caitlan D, Lyons Hannah, Holroyd-Leduc Jayna M
Cumming School of Medicine, University of Calgary, Calgary, AB.
BSc Life Science (candidate), Queen's University, Kingston, ON.
Can Geriatr J. 2022 Jun 1;25(2):222-232. doi: 10.5770/cgj.25.494. eCollection 2022 Jun.
As the population ages, the number of individuals living with dementia is increasing. This has implications for the health-care system, as people living with dementia are hospitalized more frequently and for longer periods. Because patients living with dementia are at increased risk for adverse events during admission, understanding how the acute care physical and social environments influence their outcomes is imperative. Thus, the objective of this review was to identify studies that modified the physical and/or social environment in acute care in order to improve care for hospitalized patients living with dementia.
MEDLINE, Embase, and CINAHL databases were used to search for articles up to and including June 2021. PRISMA guidelines were followed. Two independent reviewers assessed citations and full texts against the following inclusion criteria: patients living with dementia/cognitive impairment, presence of a control group, and evidence of clinical or health systems outcomes. All published English-language articles meeting inclusion criteria were retrieved.
Following the database search, 12,901 citations were retrieved with 11,334 remaining after duplication removal. Of these, 15 papers met inclusion criteria. Seven studies evaluated the physical environment (e.g., addition of electronic sensor alarms and environmental cues). The remaining studies evaluated specific programs (e.g., art, music, exercise, volunteer engagement, and virtual reality). The majority of studies were low to very low quality; only three studies were RCTs. Environmental cues may initially improve wayfinding, and exercise may reduce neuropsychiatric symptoms.
Although there are several interventions, there is a lack of high-quality evidence available to determine what exactly needs to be incorporated into acute care settings to reduce adverse outcomes for patients with dementia.
随着人口老龄化，痴呆症患者数量不断增加。这对医疗保健系统产生了影响，因为痴呆症患者住院频率更高且住院时间更长。由于痴呆症患者在住院期间发生不良事件的风险增加，了解急性护理的物理和社会环境如何影响其治疗结果至关重要。因此，本综述的目的是确定那些在急性护理中改变物理和/或社会环境以改善对住院痴呆症患者护理的研究。
使用MEDLINE、Embase和CINAHL数据库检索截至2021年6月的文章，遵循PRISMA指南。两名独立评审员根据以下纳入标准评估文献引用和全文：痴呆症/认知障碍患者、存在对照组以及临床或卫生系统结果的证据。检索所有符合纳入标准的已发表英文文章。
在数据库检索后，共检索到12901条引用，去除重复后剩余11334条。其中，15篇论文符合纳入标准。七项研究评估了物理环境（如增加电子传感器警报和环境线索）。其余研究评估了特定项目（如艺术、音乐、锻炼、志愿者参与和虚拟现实）。大多数研究质量低至极低；只有三项研究是随机对照试验。环境线索可能最初会改善寻路能力，锻炼可能会减少神经精神症状。
尽管有几种干预措施，但缺乏高质量证据来确定究竟需要在急性护理环境中纳入哪些内容以减少痴呆症患者的不良结局。
