Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia.
Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia.
BMC Geriatr. 2024 Jun 3;24(1):484. doi: 10.1186/s12877-024-05097-9.
As the ageing population grows, the demand for long-term care (LTC) services will rise, concurrently amplifying healthcare utilisation. This review aims to examine and consolidate information on LTC interventions that influence healthcare utilisation among older persons.
A scoping review was performed through a systematic search in PubMed, EBSCO CINAHL, EBM Reviews - Cochrane Database of Systematic Reviews, Embase, APA PsycInfo, EBM Reviews - Health Technology Assessment, and EBM Reviews - NHS Economic Evaluation Database. Systematic reviews with meta-analyses published between 1 January 2010 and 2 June 2022 among older persons aged 60 and above were included. The characteristics of LTC interventions were mapped to the World Health Organization (WHO) Healthy Ageing Framework. The effect sizes of healthcare utilisations for LTC interventions were recalculated using a random-effects model. The methodological quality was assessed with the AMSTAR-2 checklist, while the quality of evidence for each association was evaluated using GRADE.
Thirty-seven meta-analyses were included. The most prominent domain of the healthy ageing framework was managing chronic conditions. One hundred twelve associations between various LTC interventions and healthcare utilisations were identified, with 22 associations impacting healthcare utilisation. Four interventions were supported by suggestive or convincing evidence. Preventive home visits were found to reduce hospital admission (OR: 0.73, 95% CI: 0.59, 0.91, p = 0.005), caregiver integration during discharge planning (OR: 0.68, 95% CI: 0.57, 0.81, p < 0.001), and continuity of care (OR: 0.76, 95% CI: 0.61, 0.95, p = 0.018) reduced hospital readmission, and perioperative geriatric interventions reduced the length of hospital stay (MD: -1.50, 95% CI: -2.24, -0.76, p < 0.001). None of the associations impacted emergency department visits, medication use, and primary care utilisations with convincing evidence. Most reviews received low methodological quality.
The findings suggest that LTC interventions could benefit from transitioning to a community-based setting involving a multidisciplinary team, including carers. The spectrum of services should incorporate a comprehensive assessment to ensure continuous care.
随着人口老龄化的加剧，对长期护理（LTC）服务的需求将增加，同时也会增加医疗保健的利用。本综述旨在检查和整合影响老年人 LTC 服务利用的干预措施的信息。
通过系统检索 PubMed、EBSCO CINAHL、EBM Reviews-Cochrane 系统评价数据库、Embase、APA PsycInfo、EBM Reviews-Health Technology Assessment 和 EBM Reviews-NHS 经济评估数据库，进行范围综述。纳入 2010 年 1 月 1 日至 2022 年 6 月 2 日期间发表的针对 60 岁及以上老年人的系统评价和 meta 分析。LTC 干预措施的特征被映射到世界卫生组织（WHO）的健康老龄化框架。使用随机效应模型重新计算 LTC 干预措施对医疗保健利用的效应大小。使用 AMSTAR-2 清单评估方法学质量，使用 GRADE 评估每个关联的证据质量。
纳入了 37 项 meta 分析。健康老龄化框架最突出的领域是管理慢性病。确定了 112 个各种 LTC 干预措施与医疗保健利用之间的关联，其中 22 个关联影响医疗保健利用。四项干预措施有提示性或有说服力的证据支持。预防性家访被发现可降低住院率（OR：0.73，95%CI：0.59，0.91，p=0.005），在出院计划中整合护理人员（OR：0.68，95%CI：0.57，0.81，p<0.001）和连续性护理（OR：0.76，95%CI：0.61，0.95，p=0.018）可降低住院再入院率，围手术期老年干预措施可缩短住院时间（MD：-1.50，95%CI：-2.24，-0.76，p<0.001）。没有一项关联具有令人信服的证据表明会影响急诊就诊、药物使用和初级保健利用。大多数综述的方法学质量较低。
研究结果表明，LTC 干预措施可能受益于向包括护理人员在内的多学科团队为基础的社区环境转变。服务范围应包括全面评估，以确保连续性护理。
