School of Nursing, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong.
School of Nursing, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong.
Int J Nurs Stud. 2023 Aug;144:104524. doi: 10.1016/j.ijnurstu.2023.104524. Epub 2023 May 19.
BACKGROUND: The highly prevalent late-life loneliness, together with its deleterious health impacts, calls for increasing attention to the need for effective interventions targeting on this growing public health problem. With the increasing evidence on interventions for combating loneliness, it is timely to identify their comparative effectiveness. OBJECTIVE: This systematic review, meta-analysis and network meta-analysis was to identify and compare the effects of various non-pharmacological interventions on loneliness in community-dwelling older adults. METHODS: Systematic search was conducted in nine electronic databases from inception to 30th March 2023 for studies investigating the effects of non-pharmacological interventions on loneliness among community-dwelling older adults. The interventions were categorized according to the nature and purpose of use. Pairwise meta-analysis and network meta-analyses were sequentially performed to identify the effects of each category of interventions and their comparative intervention effectiveness, respectively. Meta-regression was performed to examine any influence of study design and participants' characteristics on the intervention effectiveness. The study protocol was registered at PROSPERO (CRD42022307621). RESULTS: A total of 60 studies with 13,295 participants were included. The interventions were categorized as psychological interventions, social support interventions (by digital and non-digital means), behavioral activation, exercise intervention with and without social engagement, multi-component intervention and health promotion. Pairwise meta-analysis identified the positive effect of psychological interventions (Hedges' g = -2.33; 95%CI [-4.40, -0.25]; Z = -2.20, p = 0.003), non-digital social support interventions (Hedges' g = -0.63; 95%CI [-1.16, -0.10]; Z = 2.33, p = 0.02) and multi-component interventions (Hedges' g = -0.28 95%CI [-0.54, -0.03]; Z = -2.15, p = 0.03) on reducing loneliness. Subgroup analysis provided additional insights: i) social support and exercise interventions which integrated active strategies to optimize the social engagement demonstrated more promising intervention effects; ii) behavioral activation and multicomponent interventions worked better for older adults who were male or reported loneliness, respectively, and iii) counseling-based psychological interventions was more effective than mind-body practice. Network meta-analysis consistently pointed to the greatest therapeutic benefits of psychological interventions, and this was followed by exercise-based interventions, non-digital social support interventions and behavioral activation. Meta-regression further suggested that the therapeutic effects of the tested interventions were independent of the various factors relating to study design and participants' characteristics. CONCLUSIONS: This review highlights the more superior effects of psychological interventions in improving loneliness among older adults. Interventions which have an attribute to optimize social dynamic and connectivity may also be effective. TWEETABLE ABSTRACT: Psychological intervention is the best to beat late-life loneliness, but increasing social dynamic and connectivity may add an impact.
背景:老年人普遍存在孤独感,且其对健康的危害日益严重,因此需要越来越多的关注来寻找有效的干预措施来解决这一日益严重的公共健康问题。随着针对孤独感干预措施的研究证据不断增加,及时确定它们的相对有效性是十分必要的。 目的:本系统评价、荟萃分析和网络荟萃分析旨在确定和比较针对社区居住的老年人孤独感的各种非药物干预措施的效果。 方法:从九个电子数据库中系统检索了截至 2023 年 3 月 30 日的研究,以调查非药物干预措施对社区居住的老年人孤独感的影响。根据使用的性质和目的对干预措施进行分类。依次进行成对荟萃分析和网络荟萃分析,以确定每类干预措施的效果及其相对干预效果。进行元回归以检验研究设计和参与者特征对干预效果的任何影响。该研究方案已在 PROSPERO(CRD42022307621)上注册。 结果:共纳入 60 项研究,涉及 13295 名参与者。干预措施分为心理干预、数字和非数字方式的社会支持干预、行为激活、有和没有社会参与的运动干预、多组分干预和健康促进。成对荟萃分析确定了心理干预(Hedges' g = -2.33;95%CI [-4.40,-0.25];Z = -2.20,p = 0.003)、非数字社会支持干预(Hedges' g = -0.63;95%CI [-1.16,-0.10];Z = 2.33,p = 0.02)和多组分干预(Hedges' g = -0.28;95%CI [-0.54,-0.03];Z = -2.15,p = 0.03)对降低孤独感的积极作用。亚组分析提供了更多的见解:i)整合了优化社会参与的主动策略的社会支持和运动干预显示出更有希望的干预效果;ii)行为激活和多组分干预分别对男性或报告孤独感的老年人更有效,iii)基于咨询的心理干预比身心实践更有效。网络荟萃分析一致指出心理干预的最大治疗益处,其次是基于运动的干预、非数字社会支持干预和行为激活。元回归进一步表明,所测试干预措施的治疗效果与研究设计和参与者特征相关的各种因素无关。 结论:本综述强调了心理干预在改善老年人孤独感方面的更优越效果。具有优化社会动态和连接性属性的干预措施也可能有效。 推文摘要:心理干预是改善老年人孤独感的最佳方法,但增加社会动态和连接性可能会产生影响。
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