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促进健康老龄化的康复服务模式——一项范围综述

Rehabilitation delivery models to foster healthy ageing-a scoping review.

作者信息

Seijas Vanessa, Maritz Roxanne, Fernandes Patricia, Bernard Renaldo M, Lugo Luz Helena, Bickenbach Jerome, Sabariego Carla

机构信息

Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.

Center for Rehabilitation in Global Health Systems (WHO Collaborating Center), Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.

出版信息

Front Rehabil Sci. 2024 Apr 5;5:1307536. doi: 10.3389/fresc.2024.1307536. eCollection 2024.

Abstract

INTRODUCTION

Rehabilitation is essential to foster healthy ageing. Older adults have unique rehabilitation needs due to a higher prevalence of non-communicable diseases, higher susceptibility to infectious diseases, injuries, and mental health conditions. However, there is limited understanding of how rehabilitation is delivered to older adults. To address this gap, we conducted a scoping review to describe rehabilitation delivery models used to optimise older adults' functioning/functional ability and foster healthy ageing.

METHODS

We searched Medline and Embase (January 2015 to May 2022) for primary studies published in English describing approaches to provide rehabilitation to older adults. Three authors screened records for eligibility and extracted data independently and in duplicate. Data synthesis included descriptive quantitative analysis of study and rehabilitation provision characteristics, and qualitative analysis to identify rehabilitation delivery models.

RESULTS

Out of 6,933 identified records, 585 articles were assessed for eligibility, and 283 studies with 69,257 participants were included. We identified six rehabilitation delivery models: outpatient (24%), telerehabilitation (22%), home (18.5%), community (16.3%), inpatient (14.6%), and eldercare (4.7%). These models often involved multidisciplinary teams (31.5%) and follow integrated care principles (30.4%). Most studies used a disease-centred approach (59.0%), while studies addressing multimorbidity (6.0%) and prevalent health problems of older adults, such as pain, low hearing, and vision, or incontinence were scarce. The most frequently provided interventions were therapeutic exercises (54.1%), self-management education (40.1%), and assessment of person-centred goals (40%). Other interventions, such as assistive technology (8.1%) and environmental adaptations (7.4%) were infrequent.

CONCLUSIONS

Focusing on primary studies, this scoping review provides an overview of rehabilitation delivery models that are used to foster healthy ageing and highlights research gaps that require further attention, including a lack of systematic assessment of functioning/functional ability, a predominance of disease-centred rehabilitation, and a scarcity of programmes addressing prevalent issues like pain, hearing/vision loss, fall prevention, incontinence, and sexual dysfunctions. Our research can facilitate evidence-based decision-making and inspire further research and innovation in rehabilitation and healthy ageing. Limitations of our study include reliance on published research to infer practice and not assessing model effectiveness. Future research in the field is needed to expand and validate our findings.

摘要

引言

康复对于促进健康老龄化至关重要。由于非传染性疾病的患病率较高、对传染病、损伤和心理健康状况的易感性较高,老年人有独特的康复需求。然而,对于如何为老年人提供康复服务的了解有限。为了填补这一空白,我们进行了一项范围综述,以描述用于优化老年人功能/功能能力和促进健康老龄化的康复服务提供模式。

方法

我们检索了Medline和Embase(2015年1月至2022年5月),查找以英文发表的描述为老年人提供康复服务方法的原始研究。三位作者独立且重复地筛选记录以确定其是否符合纳入标准并提取数据。数据综合包括对研究和康复服务提供特征的描述性定量分析,以及识别康复服务提供模式的定性分析。

结果

在识别出的6933条记录中,585篇文章被评估是否符合纳入标准,纳入了283项研究,共69257名参与者。我们确定了六种康复服务提供模式:门诊(24%)、远程康复(22%)、居家(18.5%)、社区(16.3%)、住院(14.6%)和老年护理(4.7%)。这些模式通常涉及多学科团队(31.5%)并遵循综合护理原则(30.4%)。大多数研究采用以疾病为中心的方法(59.0%),而针对多种疾病(6.0%)以及老年人常见健康问题(如疼痛、听力和视力低下或尿失禁)的研究较少。最常提供的干预措施是治疗性锻炼(54.1%)、自我管理教育(40.1%)和以个人为中心目标的评估(40%)。其他干预措施,如辅助技术(8.1%)和环境改造(7.4%)则较少见。

结论

本范围综述聚焦于原始研究,概述了用于促进健康老龄化的康复服务提供模式,并突出了需要进一步关注的研究空白,包括缺乏对功能/功能能力的系统评估、以疾病为中心的康复占主导地位,以及解决疼痛、听力/视力丧失、预防跌倒、尿失禁和性功能障碍等常见问题的项目稀缺。我们的研究可以促进基于证据的决策,并激发康复和健康老龄化领域的进一步研究与创新。我们研究的局限性包括依赖已发表研究来推断实践情况且未评估模式有效性。该领域未来需要开展研究以扩展和验证我们的研究结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7896/11041397/d1d12b957df1/fresc-05-1307536-g001.jpg

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