基于社区的复杂干预措施,以维持老年人的独立性,按脆弱分层:系统性审查和网络元分析
Thomas Frederick Crocker1, Natalie Lam1, Joie Ensor2
1Academic Unit for Ageing and Stroke Research (University of Leeds), Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
Health technology assessment (Winchester, England)
|September 10, 2024
概括
社区卫生服务可以帮助老年人保持独立,多因素行动,药物审查和持续的患者审查显示最有前途. 然而,证据质量往往很低,一些干预措施可能会降低独立性.
科学领域:
- 老年学与公共卫生
- 证据综合和卫生技术评估
背景情况:
- 保持老年人的独立性至关重要,但对有效社区卫生和护理服务的指导是有限的.
- 识别促进独立性的干预措施和检查脆弱性的作用对于有针对性的支持至关重要.
研究的目的:
- 综合有关社区服务在维持老年人独立性方面的有效性证据.
- 按组件分组干预措施,并调查脆弱性是否会缓和它们的效果.
主要方法:
- 一个系统的审查和随机对照试验 (RCT) 和集群RCT的网络元分析,涉及老年人 (65岁以上).
- 干预措施被编码和分组;人口被按脆弱性分类. 评估了偏见风险和证据的确定性.
主要成果:
- 包括129项研究 (74946名参与者). 多因素作用 (多领域评估/规划) 与药物审查相结合,显示维持独立性的中等确定性.
- 某些干预组合,包括多因素作用和药物审查,有利于日常生活和家庭护理接受者的工具活动.
- 对日常生活的个人活动,养老院安置和经济结果的证据是不确定的或不确定的;一些干预措施可能会减少独立性.
结论:
- 虽然许多干预组合显示出小而不确定的效果,但多因素作用,药物审查和持续的患者审查似乎对维持独立性最有希望.
- 偏差的高风险和不准确的估计导致大多数发现的确定性较低,需要谨慎解释和进一步研究.
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