Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis.
Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis.
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DOI：
10.1016/s0140-6736(08)60342-6
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发表时间：
2008-03-01
期刊：
影响因子：
168.9
通讯作者：
Ebrahim, Shah
中科院分区：
文献类型：
--
作者：
Beswick, Andrew D.;Rees, Karen;Dieppe, Paul;Ayis, Salma;Gooberman-Hill, Rachael;Horwood, Jeremy;Ebrahim, Shah
在老年，身体机能下降导致丧失独立性，需要住院和长期疗养院护理，以及过早死亡。我们做了一个系统的回顾，以评估以社区为基础的综合干预措施在保护老年人的身体功能和独立性方面的有效性。我们系统地检索了随机对照试验，这些试验评估了对居住在家中的老年人（平均年龄至少65岁）进行的基于社区的多因素干预，并进行了至少6个月的随访。研究的结局包括居家生活、死亡、疗养院和住院、福尔斯和身体功能。我们对提取的数据进行了荟萃分析。我们确定了89个试验，包括97984人。 干预措施降低了不在家生活的风险（相对风险[RR] 0.95，95%CI 0.93 - 0.97）。干预减少了疗养院的入院率（0.87，0.83 - 0.90），但没有减少死亡率（1.00，0.97 - 1.02）。干预组的住院风险（0·94，0·91 - 0·97）和福尔斯风险（0·90，0·86 - 0·95）降低，身体功能（标准化平均差异-0·08，-0·11至-0·06）优于其他组。没有注意到任何特定类型或强度的干预的益处。在死亡率增加的人群中，干预措施与减少疗养院入院有关。在1993年之前开始的研究中，试验中的获益尤其明显。复杂的干预措施可以帮助老年人安全和独立地生活，并可以根据个人的需要和偏好进行调整。
In old age, reduction in physical function leads to loss of independence, the need for hospital and long-term nursing-home care, and premature death. We did a systematic review to assess the effectiveness of community-based complex interventions in preservation of physical function and independence in elderly people. We searched systematically for randomised controlled trials assessing community-based multifactorial interventions in elderly people (mean age at least 65 years) living at home with at least 6 months of follow-up. Outcomes studied were living at home, death, nursing-home and hospital admissions, falls, and physical function. We did a meta-analysis of the extracted data. We identified 89 trials including 97 984 people. Interventions reduced the risk of not living at home (relative risk [RR] 0·95, 95% CI 0·93–0·97). Interventions reduced nursing-home admissions (0·87, 0·83–0·90), but not death (1·00, 0·97–1·02). Risk of hospital admissions (0·94, 0·91–0·97) and falls (0·90, 0·86–0·95) were reduced, and physical function (standardised mean difference −0·08, −0·11 to −0·06) was better in the intervention groups than in other groups. Benefit for any specific type or intensity of intervention was not noted. In populations with increased death rates, interventions were associated with reduced nursing-home admission. Benefit in trials was particularly evident in studies started before 1993. Complex interventions can help elderly people to live safely and independently, and could be tailored to meet individuals' needs and preferences.