Efficacy of Mealtime Interventions for Malnutrition and Oral Intake in Persons With Dementia: A Systematic Review.
Efficacy of Mealtime Interventions for Malnutrition and Oral Intake in Persons With Dementia: A Systematic Review.
复制标题
进餐时间干预的营养不良和痴呆患者口服摄入的功效：系统评价。
DOI：
10.1097/wad.0000000000000387
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发表时间：
2020-10
影响因子：
2.1
通讯作者：
Rogus-Pulia N
中科院分区：
文献类型：
--
作者：
Borders JC;Blanke S;Johnson S;Gilmore-Bykovskyi A;Rogus-Pulia N
营养不良和体重减轻在阿尔茨海默氏症和相关痴呆症患者中非常普遍。口服摄入是解决这些营养后果的重要干预目标。然而，干预措施的有效性仍然知之甚少，因为先前的综合研究未能研究干预措施对痴呆症患者营养不良的影响和假设的作用机制。本综述旨在确定餐时干预措施改善痴呆患者口服摄入量和营养结果的有效性。4个数据库共产生了1712项研究，其中32项研究符合纳入标准。研究包括教育、环境改造、喂养、口服补充剂和其他药理学/生态心理学干预措施。虽然大多数研究报告了至少一种营养结局的统计学显著改善，但研究设计和结局指标各不相同，许多研究缺乏足够的统计把握度或盲法。总的来说，我们发现了适度的证据表明口服补充剂的疗效，初步证据表明喂养干预，教育和环境改造可能会带来改善。研究结果澄清了现有的证据，改善痴呆症患者营养不良的各种干预策略的状态。虽然有些方法是有前途的，但需要有足够的动力和严格设计的多维干预试验，以告知现实世界背景下的临床决策。
Malnutrition and weight loss are highly prevalent in persons with Alzheimer’s and related dementias. Oral intake is an important interventional target for addressing these nutritional consequences. However, the efficacy of interventions remains poorly understood as prior syntheses have failed to examine the impact of intervention approaches on malnutrition and hypothesized mechanisms of action in persons with dementia. This review aimed to determine the efficacy of mealtime interventions to improve oral intake and nutritional outcomes in persons with dementia. Four databases yielded 1712 studies, resulting in 32 studies that met inclusion criteria. Studies included education, environmental modifications, feeding, oral supplementation, and other pharmacologic/ecopsychological interventions. While the majority of studies reported statistically significant improvements in at least one nutritional outcome, study design and outcome measures were heterogeneous with many lacking adequate statistical power or blinding. Collectively, we found moderate evidence to suggest the efficacy of oral supplementation, and preliminary evidence to suggest that feeding interventions, education, and environmental modifications may confer improvements. Findings clarify the state of existing evidence regarding various interventional strategies for improving malnutrition in persons with dementia. While some approaches are promising, adequately powered and rigorously designed multi-dimensional intervention trials are needed to inform clinical decision-making in real-world contexts.