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英格兰痴呆症一级预防政策的范围审查:它们是否平衡了覆盖范围和能动性?

Scoping review of dementia primary prevention policies in England: do they balance reach and agency?

作者信息

Walsh Sebastian, Birch Jack M, Merrick Richard, Wallace Lindsay, Kuhn Isla, Clare Linda, Mytton Oliver T, Lafortune Louise, Wills Wendy J, Brayne Carol E

机构信息

Cambridge Public Health, University of Cambridge, Cambridge, UK.

Newcastle University, Newcastle upon Tyne, UK.

出版信息

BMJ Public Health. 2025 Jun 25;3(1):e002631. doi: 10.1136/bmjph-2025-002631. eCollection 2025.


DOI:10.1136/bmjph-2025-002631
PMID:40575065
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12198788/
Abstract

OBJECTIVES: To ascertain the balance of dementia risk reduction policies in England, considering their reach (population-wide vs targeted at specific individuals) and agency (the level of resource required to benefit from the intervention). DESIGN: Scoping review. DATA SOURCES: Academic databases (Medline, the Health Management Information Consortium and Overton) and the webpages of relevant national and local government agencies and associated bodies (including: the UK Government, the UK Health Security Agency, National Health Service England, National Institute for Health and Care Excellence and local governments and healthcare organisations from the East of England region) were searched. ELIGIBILITY CRITERIA: Any written documents or service webpages from, or endorsed by, governmental organisations or arms-length bodies which describe, recommend or evaluate current or formally proposed interventions for the reduction or control of one or more modifiable risk factors for dementia were included. Policies targeted at people with existing cognitive impairment and/or dementia were excluded. DATA EXTRACTION AND SYNTHESIS: Data on policy description, reach and agency were extracted from identified dementia primary prevention policy documents by one author. Policies common to several organisations were grouped, and then synthesised across risk factor group and by tier of government. The numerical balance of policies (between axes of reach and agency) was compared across risk factor group and current policy/proposed status. RESULTS: From a total of 8210 hits, 366 policy documents were included. From these, 79 distinct policies were identified, targeted at dementia (n=3), cardiovascular health (n=23), smoking and alcohol (n=17), depression and social isolation (n=12), air pollution (n=10), low formal education (n=9), hearing impairment (n=3) and traumatic brain injury (n=2). Overall, 67.1% (53/79) of current policies had population-reach, 53.2% (42/79) were considered low-agency and 39.2% (31/79) were both population-reach and low-agency. CONCLUSIONS: There is currently a policy balance between population-reach and targeted-reach, and high-agency and low-agency interventions, for dementia risk reduction in England. However, a predominance of population-reach, low-agency interventions may be required to match the scale of the challenge and improve equity.

摘要

目的:考虑痴呆症风险降低政策的覆盖范围(全人群覆盖与针对特定个体)和实施机构(从干预措施中受益所需的资源水平),确定英格兰痴呆症风险降低政策的平衡情况。 设计:范围综述。 数据来源:检索学术数据库(Medline、健康管理信息联盟和奥弗顿)以及相关国家和地方政府机构及相关团体的网页(包括:英国政府、英国卫生安全局、英格兰国民医疗服务体系、国家卫生与临床优化研究所,以及英格兰东部地区的地方政府和医疗保健组织)。 纳入标准:纳入政府组织或独立机构撰写或认可的任何书面文件或服务网页,这些文件描述、推荐或评估了当前或正式提议的用于降低或控制一种或多种可改变的痴呆症风险因素的干预措施。针对现有认知障碍和/或痴呆症患者的政策被排除。 数据提取与综合:由一位作者从已识别的痴呆症一级预防政策文件中提取有关政策描述、覆盖范围和实施机构的数据。将几个组织共有的政策进行分组,然后按风险因素组和政府层级进行综合。在风险因素组和当前政策/提议状态之间比较政策的数值平衡(在覆盖范围和实施机构两个轴之间)。 结果:在总共8210条搜索结果中,纳入了366份政策文件。从中确定了79项不同的政策,针对痴呆症(n = 3)、心血管健康(n = 23)、吸烟和饮酒(n = 17)、抑郁和社会隔离(n = 12)、空气污染(n = 10)、低学历(n = 9)、听力障碍(n = 3)和创伤性脑损伤(n = 2)。总体而言,67.1%(53/79)的现行政策具有全人群覆盖范围,53.2%(42/79)被认为实施机构资源需求低,39.2%(31/79)既具有全人群覆盖范围且实施机构资源需求低。 结论:目前在英格兰,降低痴呆症风险的政策在全人群覆盖与针对性覆盖、高资源需求与低资源需求干预措施之间存在平衡。然而,可能需要以全人群覆盖、低资源需求的干预措施为主,以应对挑战规模并改善公平性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c1b8/12198788/e44130acbb59/bmjph-3-1-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c1b8/12198788/0da9c3e6c3bd/bmjph-3-1-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c1b8/12198788/a4a4b7d832b2/bmjph-3-1-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c1b8/12198788/e44130acbb59/bmjph-3-1-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c1b8/12198788/0da9c3e6c3bd/bmjph-3-1-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c1b8/12198788/a4a4b7d832b2/bmjph-3-1-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c1b8/12198788/e44130acbb59/bmjph-3-1-g003.jpg

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本文引用的文献

[1]
Universal Prevention of Dementia in Italy: A Document Analysis of the 21 Italian Regional Prevention Plans.

J Prev Alzheimers Dis. 2024

[2]
Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission.

Lancet. 2024-8-10

[3]
Benefits of population-level interventions for dementia risk factors: an economic modelling study for England.

Lancet Healthy Longev. 2024-9

[4]
Population-level interventions for the primary prevention of dementia: a complex evidence review.

EClinicalMedicine. 2024-3-10

[5]
Are Population-Level Approaches to Dementia Risk Reduction Under-Researched? A Rapid Review of the Dementia Prevention Literature.

J Prev Alzheimers Dis. 2024

[6]
What is a population-level approach to prevention, and how could we apply it to dementia risk reduction?

Public Health. 2023-12

[7]
Exploring English policymakers' attitudes towards dementia risk reduction: A qualitative study.

Int J Geriatr Psychiatry. 2023-10

[8]
Estimating Dementia Risk Using Multifactorial Prediction Models.

JAMA Netw Open. 2023-6-1

[9]
Lecanemab for Alzheimer's disease.

BMJ. 2022-12-19

[10]
The relevance of social and commercial determinants for neurological health.

Lancet Neurol. 2022-12

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