Tao An, Ho Ken Hok Man, Yang Chen, Chan Helen Yue Lai
The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
Int J Nurs Stud. 2023 Apr;140:104437. doi: 10.1016/j.ijnurstu.2023.104437. Epub 2023 Jan 14.
Older people with frailty are more likely to experience negative psychological well-being, depressive symptoms, anxiety, and stress. Deterioration of psychological outcomes, in turn, further aggravates the frailty status among this vulnerable population. Considering the undesirable effects of polypharmacy on older people, the use of non-pharmacological intervention has attracted increasing attention. However, the effects of non-pharmacological interventions on psychological outcomes are not clear.
This review aims to systematically identify and synthesise evidence to examine the effectiveness of non-pharmacological interventions on psychological outcomes among older people with frailty.
Eight electronic databases, including PubMed, MEDLINE, EMBASE, CINAHL, APA PsycInfo, Cochrane Library, CNKI and WANFANG were searched from inception to 14 November 2022. Randomised controlled trials and clinical controlled trials of non-pharmacological interventions on psychological outcomes in older people with frailty were included. The quality of the included studies was assessed using The Cochrane Risk of Bias Tool v2. Meta-analysis was performed using the RevMan5.3. The certainty of the evidence was evaluated by GRADE approach.
A total of 4726 articles were initially identified and screened for title and abstract. Eventually, 13 articles from 11 studies were included in this review. The results of the overall risk of bias indicated that four studies had low risk; five studies had some concerns, and two studies had high risk. Four types of intervention were identified, including physical exercise (n = 3), complementary and alternative medicine (music therapy = 1, acupressure = 1), case management (n = 5), and advance care planning (n = 1). The pooled analysis showed that group-based physical exercise had significant beneficial effects on depressive symptoms (SMD: -0.46, 95% CI: -0.81 to -0.10, p = .01; low certainty). There is no difference between the effects of case management and usual care on depressive symptoms (SMD: 0.02, 95% CI: -0.14 to 0.19, p = .79; high certainty). Narrative synthesis of evidence suggested the effects of complementary and alternative medicine on improving depressive symptoms and general mental status.
Psychological outcomes in older people with frailty are understudied. Group-based physical exercise could be a strategy to reduce depressive symptoms among older people with frailty. There is limited evidence showing the effects of complementary and alternative medicine on improving psychological outcomes. More rigorous trials are needed to examine the effects of non-pharmacological interventions on psychological outcomes among older people with frailty.
(PROSPERO): CRD42022303370.
体弱的老年人更有可能经历负面的心理健康、抑郁症状、焦虑和压力。而心理状况的恶化反过来又会进一步加剧这一弱势群体的虚弱状态。考虑到多重用药对老年人的不良影响，非药物干预的应用越来越受到关注。然而，非药物干预对心理状况的影响尚不清楚。
本综述旨在系统地识别和综合证据，以检验非药物干预对体弱老年人心理状况的有效性。
检索了8个电子数据库，包括PubMed、MEDLINE、EMBASE、CINAHL、APA PsycInfo、Cochrane图书馆、中国知网和万方，检索时间从建库至2022年11月14日。纳入了关于非药物干预对体弱老年人心理状况影响的随机对照试验和临床对照试验。使用Cochrane偏倚风险工具v2评估纳入研究的质量。使用RevMan5.3进行荟萃分析。采用GRADE方法评估证据的确定性。
初步检索到4726篇文章，并对其标题和摘要进行了筛选。最终，本综述纳入了来自11项研究的13篇文章。总体偏倚风险结果显示，4项研究风险较低；5项研究存在一些问题，2项研究风险较高。确定了4种干预类型，包括体育锻炼（n = 3）、补充和替代医学（音乐疗法 = 1，指压疗法 = 1）、病例管理（n = 5）和预先护理计划（n = 1）。汇总分析表明，基于群体的体育锻炼对抑郁症状有显著的有益影响（标准化均数差：-0.46，95%置信区间：-0.81至-0.10，p = 0.01；低确定性）。病例管理和常规护理对抑郁症状的影响没有差异（标准化均数差：0.02，95%置信区间：-0.14至0.19，p = 0.79；高确定性）。证据的叙述性综合表明，补充和替代医学对改善抑郁症状和总体心理状态有影响。
对体弱老年人的心理状况研究不足。基于群体的体育锻炼可能是减轻体弱老年人抑郁症状的一种策略。仅有有限的证据表明补充和替代医学对改善心理状况有影响。需要更严格的试验来检验非药物干预对体弱老年人心理状况的影响。
（PROSPERO）：CRD42022303370。
