《居住型老年护理中为痴呆症患者提供以患者为中心的护理服务：系统评价和荟萃分析》。
The Delivery of Person-Centered Care for People Living With Dementia in Residential Aged Care: A Systematic Review and Meta-Analysis.
机构信息
Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Mission & Corporate Development, Baptcare, Melbourne, Victoria, Australia.
出版信息
Gerontologist. 2024 May 1;64(5). doi: 10.1093/geront/gnad052.
BACKGROUND AND OBJECTIVES
Person-centered care is the gold standard of care for people living with dementia, yet few systematic reviews have detailed how it is delivered in practice. This mixed-methods review aimed to examine the delivery of person-centered care, and its effectiveness, for people living with dementia in residential aged care.
RESEARCH DESIGN AND METHODS
A systematic review and meta-analysis. Eligible studies were identified across 4 databases. Quantitative and qualitative studies containing data on person-centered care delivered to people with dementia living in residential aged care were included. Meta-analysis using a random-effects model was conducted where more than 3 studies measured the same outcome. A narrative meta-synthesis approach was undertaken to categorize verbatim participant quotes into representative themes. Risk of bias was undertaken using quality appraisal tools from the Joanna Briggs Institute.
RESULTS
41 studies were identified for inclusion. There were 34 person-centered care initiatives delivered, targeting 14 person-centered care outcomes. 3 outcomes could be pooled. Meta-analyses demonstrated no reduction in agitation (standardized mean difference -0.27, 95% confidence interval [CI], -0.58, 0.03), improvement in quality of life (standardized mean difference -0.63, 95% CI: -1.95, 0.70), or reduced neuropsychiatric symptoms (mean difference -1.06, 95% CI: -2.16, 0.05). Narrative meta-synthesis revealed barriers (e.g., time constraints) and enablers (e.g., staff collaboration) to providing person-centered care from a staff perspective.
DISCUSSION AND IMPLICATIONS
The effectiveness of person-centered care initiatives delivered to people with dementia in residential aged care is conflicting. Further high-quality research over an extended time is required to identify how person-centered care can be best implemented to improve resident outcomes.
背景与目的
以患者为中心的护理是痴呆患者护理的黄金标准，但很少有系统评价详细说明其在实践中的实施方式。本混合方法综述旨在研究以患者为中心的护理在养老机构中痴呆患者中的实施情况及其效果。
研究设计与方法
系统综述和荟萃分析。在 4 个数据库中确定了合格的研究。纳入了包含以居住在养老机构中的痴呆患者为对象的以患者为中心的护理实施情况及其效果数据的定量和定性研究。对超过 3 项研究测量相同结局的研究进行了使用随机效应模型的荟萃分析。采用叙述性元综合方法，将参与者的原话分类为代表性主题。使用 Joanna Briggs 研究所的质量评估工具进行偏倚风险评估。
结果
确定了 41 项符合纳入标准的研究。共实施了 34 项以患者为中心的护理举措，针对 14 项以患者为中心的护理结局。有 3 项结局可进行汇总。荟萃分析显示，激动症状无减轻（标准化均数差-0.27，95%置信区间[CI]：-0.58，0.03），生活质量无改善（标准化均数差-0.63，95% CI：-1.95，0.70），或神经精神症状无减少（差值-1.06，95% CI：-2.16，0.05）。从员工角度进行叙述性元综合分析揭示了提供以患者为中心的护理的障碍（例如，时间限制）和促进因素（例如，员工合作）。
讨论与意义
在养老机构中对痴呆患者实施的以患者为中心的护理举措的效果存在争议。需要进一步进行高质量、长时间的研究，以确定如何最好地实施以患者为中心的护理，以改善患者结局。
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