旨在减轻老年人非正式照护负面健康后果的干预措施的效果：系统评价和荟萃分析的伞式综述。
Effectiveness of interventions designed to mitigate the negative health outcomes of informal caregiving to older adults: an umbrella review of systematic reviews and meta-analyses.
机构信息
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden.
出版信息
BMJ Open. 2023 Apr 21;13(4):e068646. doi: 10.1136/bmjopen-2022-068646.
OBJECTIVES
This umbrella review aimed to evaluate whether certain interventions can mitigate the negative health consequences of caregiving, which interventions are more effective than others depending on the circumstances, and how these interventions are experienced by caregivers themselves.
DESIGN
An umbrella review of systematic reviews was conducted.
DATA SOURCES
Quantitative (with or without meta-analyses), qualitative and mixed-methods systematic reviews were included.
ELIGIBILITY CRITERIA
Reviews were considered eligible if they met the following criteria: included primary studies targeting informal (ie, unpaid) caregivers of older people or persons presenting with ageing-related diseases; focused on support interventions and assessed their effectiveness (quantitative reviews) or their implementation and/or lived experience of the target population (qualitative reviews); included physical or mental health-related outcomes of informal caregivers.
DATA EXTRACTION AND SYNTHESIS
A total of 47 reviews were included, covering 619 distinct primary studies. Each potentially eligible review underwent critical appraisal and citation overlap assessment. Data were extracted independently by two reviewers and cross-checked. Quantitative review results were synthesised narratively and presented in tabular format, while qualitative findings were compiled using the mega-aggregation framework synthesis method.
RESULTS
The evidence regarding the effectiveness of interventions on physical and mental health outcomes was inconclusive. Quantitative reviews were highly discordant, whereas qualitative reviews only reported practical, emotional and relational benefits. Multicomponent and person-centred interventions seemed to yield highest effectiveness and acceptability. Heterogeneity among caregivers, care receivers and care contexts was often overlooked. Important issues related to the low quality of evidence and futile overproduction of similar reviews were identified.
CONCLUSIONS
Lack of robust evidence calls for better intervention research and evaluation practices. It may be warranted to avoid one-size-fits-all approaches to intervention design. Primary care and other existing resources should be leveraged to support interventions, possibly with increasing contributions from the non-profit sector.
PROSPERO REGISTRATION NUMBER
CRD42021252841; BMJ Open: doi:10.1136/bmjopen-2021-053117.
目的
本综述旨在评估某些干预措施是否可以减轻照料者的负面健康后果，以及根据具体情况哪些干预措施更有效，以及照料者自身对这些干预措施的体验如何。
设计
对系统综述进行伞式综述。
数据来源
纳入了定量（有或没有荟萃分析）、定性和混合方法系统综述。
入选标准
如果符合以下标准，则认为综述符合入选条件：纳入针对老年人或出现与衰老相关疾病的非正式（即无报酬）照料者的原始研究；关注支持干预措施，并评估其效果（定量综述）或目标人群的实施情况和/或生活体验（定性综述）；包括非正式照料者的身心健康结果。
数据提取和综合
共纳入 47 篇综述，涵盖了 619 项独立的原始研究。对每一篇可能符合条件的综述进行了批判性评估和引用重叠评估。数据由两名评审员独立提取，并进行交叉核对。定量综述结果以叙述方式进行综合，并以表格形式呈现，而定性研究结果则使用 mega-aggregation 框架综合方法进行汇编。
结果
干预措施对身心健康结果的有效性证据尚无定论。定量综述结果差异很大，而定性综述仅报告了实际的、情感的和关系方面的益处。多组分和以人为中心的干预措施似乎效果最好，也最能被接受。对照料者、照料对象和照料环境的异质性往往被忽视。证据质量低和类似综述重复生产过多等重要问题也被确定。
结论
缺乏稳健的证据呼吁进行更好的干预研究和评估实践。避免一刀切的干预设计方法可能是必要的。初级保健和其他现有资源应被利用来支持干预措施，可能需要非营利部门做出更多贡献。
PROSPERO 注册号：CRD42021252841；BMJ Open：doi:10.1136/bmjopen-2021-053117。
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