The effectiveness and cost-effectiveness of respite for caregivers of frail older people
The effectiveness and cost-effectiveness of respite for caregivers of frail older people
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DOI：
10.1111/j.1532-5415.2006.01037.x
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发表时间：
2007-02-01
影响因子：
6.3
通讯作者：
Drummond, Michael
中科院分区：
文献类型：
--
作者：
Mason, Anne;Weatherly, Helen;Drummond, Michael
在工业化世界中，体弱多病的老年人的比例正在增加。暂缓护理是维持这些人及其照顾者生活质量的一种潜在的重要方式。这项系统性审查的目的是确定为虚弱老年人及其照顾者提供不同社区临终关怀模式的有效性和成本效益。为了确定相关研究，检索了37个数据库，并进行了参考文献检查和引文检索。控制良好的有效性研究有资格被纳入，而非控制的研究只有在没有更高质量的证据的情况下才能被接受。与常规护理或其他支持干预相比，研究评估了基于社区的喘息对虚弱老年人照顾者的影响。符合条件的经济评价还涉及成本问题。在适当的情况下，使用标准的荟萃分析技术合成数据。10个随机对照试验、7个准实验研究和5个非对照研究纳入综述。对于所有类型的喘息，对照顾者的影响通常很小，更好的对照研究发现，只有特定的亚组才有适度的好处，尽管许多研究报告了照顾者的高水平满意度。没有发现可靠的证据表明，暂缓护理会推迟进入寄宿护理的时间，或者对虚弱的老年人产生不利影响。经济评估都对日托进行了评估，日托往往与普通护理的费用相似或更高。鉴于体弱多病的老年人越来越多，而所有类型的临终关怀缺乏最新的、高质量的证据，迫切需要更高质量的证据来指导当前的政策和做法。
The proportion of frail elderly people in the industrialized world is increasing. Respite care is a potentially important way of maintaining the quality of life for these people and their caregivers. The objective of this systematic review was to determine the effectiveness and cost-effectiveness of different models of community-based respite care for frail older people and their caregivers. To identify relevant studies, 37 databases were searched, and reference checking and citation searches were undertaken. Well-controlled effectiveness studies were eligible for inclusion, with uncontrolled studies admissible only in the absence of higher-quality evidence. Studies assessed the effect of community-based respite on caregivers of frail elderly people relative to usual care or to another support intervention. Eligible economic evaluations also addressed costs. Where appropriate, data were synthesized using standard meta-analytic techniques. Ten randomized, controlled trials, seven quasi-experimental studies and five uncontrolled studies were included in the review. For all types of respite, the effects upon caregivers were generally small, with better-controlled studies finding modest benefits only for certain subgroups, although many studies reported high levels of caregiver satisfaction. No reliable evidence was found that respite care delays entry to residential care or adversely affects frail older people. The economic evaluations all assessed day care, which tended to be associated with similar or higher costs than usual care. Given the increasing numbers of frail elderly people and the lack of up-to-date, good-quality evidence for all types of respite care, better-quality evidence is urgently needed to inform current policy and practice.