Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
J Am Geriatr Soc. 2023 Nov;71(11):3609-3621. doi: 10.1111/jgs.18522. Epub 2023 Aug 1.
Nursing home admission remains a central outcome in many healthcare systems and community-based programs. The objective of this meta-analysis was to determine the efficacy of pharmacological and nonpharmacological interventions in preventing nursing home admission for adults aged 65 years or older.
MEDLINE, EMBASE, PsycInfo, CINAHL, and the Cochrane Library were all last searched in March 2022 to identify up-to-date eligible studies for the meta-analysis. Two reviewers screened each abstract independently. In instances where reviewers disagreed as to inclusion, all reviewers convened to review the Abstract to come to a consensus decision regarding inclusion. Two reviewers independently collected data from each report. Disagreements were resolved using group consensus. The first author reviewed the narrative descriptions of intervention components to create a categorization scheme for the various interventions evaluated in selected studies. These categorizations were reviewed with the co-authors (second-fifth) and collapsed to create the final classification of intervention type. Study risk of bias was assessed using an instrument developed based on Agency for Healthcare Research & Quality (AHRQ) guidance. Differences between the percentages of participants in treatment versus control arms was the outcome of interest.
Two-hundred and eighty-three studies with a total of 203,735 older persons were included in the meta-analysis. Specialty geriatrics care (OR = 0.77, 95% CI, 0.60-0.99), multicomponent interventions (OR = 0.82, 95% CI, 0.67-0.99), and cognitive stimulation (OR = 0.60, 95% CI, 0.38-0.96) were associated with less frequent nursing home admission. Home-based and inpatient/discharge management interventions approached statistical significance but were not associated with reduced institutionalization.
Even in the face of complex care needs, older adults wish to live at home. Effectively disseminating and implementing geriatric care principles across healthcare encounters could achieve a highly valued and preferred outcome in older adulthood: aging in place.
养老院入院仍然是许多医疗保健系统和基于社区的项目的一个核心结果。本荟萃分析的目的是确定药物和非药物干预措施预防 65 岁或以上成年人入住养老院的效果。
2022 年 3 月，我们对 MEDLINE、EMBASE、PsycInfo、CINAHL 和 Cochrane 图书馆进行了最新检索，以确定荟萃分析的最新合格研究。两名评审员独立筛选每个摘要。如果评审员对纳入存在分歧，则所有评审员开会审查摘要，以就纳入达成共识决定。两名评审员独立从每份报告中收集数据。分歧通过小组协商解决。第一作者审查了干预措施组成部分的叙述描述，为选定研究中评估的各种干预措施创建了一个分类方案。这些分类方案与合著者（第二至第五作者）一起进行了审查，并进行了合并，以创建最终的干预类型分类。使用基于医疗保健研究与质量局 (AHRQ) 指南制定的工具评估研究的偏倚风险。治疗组与对照组参与者百分比之间的差异是感兴趣的结果。
共有 283 项研究，总计 203735 名老年人纳入荟萃分析。专科老年医学护理（OR=0.77，95%CI，0.60-0.99）、多组分干预（OR=0.82，95%CI，0.67-0.99）和认知刺激（OR=0.60，95%CI，0.38-0.96）与较少的养老院入院相关。家庭为基础和住院/出院管理干预措施接近统计学意义，但与减少机构化无关。
即使在存在复杂护理需求的情况下，老年人也希望在家中生活。在医疗保健接触中有效地传播和实施老年医学护理原则，可以实现老年人非常重视和期望的结果：安享晚年。
