The impact of interventions on management of frailty in hospitalized frail older adults: a systematic review and meta-analysis.
The impact of interventions on management of frailty in hospitalized frail older adults: a systematic review and meta-analysis.
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DOI：
10.1186/s12877-020-01935-8
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发表时间：
2020-12-03
期刊：
影响因子：
4.1
通讯作者：
Ghaedamini Harouni G
中科院分区：
文献类型：
--
作者：
Rezaei-Shahsavarloo Z;Atashzadeh-Shoorideh F;Gobbens RJJ;Ebadi A;Ghaedamini Harouni G
老年人面临的最具挑战性的问题之一是虚弱的临床状态。虚弱被定义为心理、身体和社会功能的累积下降。住院治疗是老年人变得虚弱的最紧张的事件之一。本研究的目的是确定干预措施的有效性，重点是管理虚弱住院老年人。使用Medline、Embase、科克伦、ProQuest、CINAHL、SCOPUS和Web of Science电子数据库对2000年至2019年发表的论文进行了系统综述和荟萃分析。随机对照研究包括旨在管理住院老年人的虚弱。检查的结果包括虚弱;身体，心理和社会领域;住院时间;再住院;死亡率;患者满意度;以及出院后安置的需要。在筛选了7976条记录和243篇全文文章后，纳入了7项研究（3项干预措施），涉及1009例住院老年患者。这些研究的质量一般或较差，研究中发表偏倚的风险较低。研究的荟萃分析显示，干预组和对照组在住院老年人虚弱管理方面存在统计学显著差异（ES = 0. 35; 95% CI：0. 05）。067-0.632; z = 2.43; P < 0.015）。然而，纳入的研究均未评估社会地位，只有少数研究评估了其他次要结局。分析还表明，综合老年评估单位干预措施在解决身体和心理脆弱，再住院，死亡率和患者满意度方面是有效的。对住院的体弱老年人进行干预是有效的管理虚弱。由多学科专家团队在老年病环境中进行的多维干预可能是有效的住院体弱老人的护理。由于在医院环境中进行的随机对照试验数量少，现有研究质量低，因此需要进行新的随机对照试验，以制定适合体弱老年人的方案。在线版本包含补充材料，可通过10.1186/s12877-020-01935-8获得。
One of the most challenging issues for the elderly population is the clinical state of frailty. Frailty is defined as a cumulative decline across psychological, physical, and social functioning. Hospitalization is one of the most stressful events for older people who are becoming frail. The aim of the present study was to determine the effectiveness of interventions focused on management of frailty in hospitalized frail older adults. A systematic review and meta-analysis of research was conducted using the Medline, Embase, Cochrane, ProQuest, CINAHL, SCOPUS and Web of Science electronic databases for papers published between 2000 and 2019. Randomized controlled studies were included that were aimed at the management of frailty in hospitalized older adults. The outcomes which were examined included frailty; physical, psychological, and social domains; length of stay in hospital; re-hospitalization; mortality; patient satisfaction; and the need for post discharge placement. After screening 7976 records and 243 full-text articles, seven studies (3 interventions) were included, involving 1009 hospitalized older patients. The quality of these studies was fair to poor and the risk of publication bias in the studies was low. Meta-analysis of the studies showed statistically significant differences between the intervention and control groups for the management of frailty in hospitalized older adults (ES = 0.35; 95% CI: 0. 067–0.632; z = 2.43; P < 0.015). However, none of the included studies evaluated social status, only a few of the studies evaluated other secondary outcomes. The analysis also showed that a Comprehensive Geriatric Assessment unit intervention was effective in addressing physical and psychological frailty, re-hospitalization, mortality, and patient satisfaction. Interventions for hospitalized frail older adults are effective in management of frailty. Multidimensional interventions conducted by a multidisciplinary specialist team in geriatric settings are likely to be effective in the care of hospitalized frail elderly. Due to the low number of RCTs carried out in a hospital setting and the low quality of existing studies, there is a need for new RCTs to be carried out to generate a protocol appropriate for frail older people. The online version contains supplementary material available at 10.1186/s12877-020-01935-8.
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