Meta-analysis of psychosocial interventions for caregivers of people with dementia
Meta-analysis of psychosocial interventions for caregivers of people with dementia
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DOI：
10.1034/j.1600-0579.2003.00210.x
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发表时间：
2003-05-01
影响因子：
6.3
通讯作者：
Koschera, A
中科院分区：
文献类型：
--
作者：
Brodaty, H;Green, A;Koschera, A
目的：回顾已发表的痴呆症患者护理人员 (CG) 干预措施（不包括暂托护理）的报告，并向临床医生提供建议。设计：荟萃分析回顾。对电子数据库和关键文章进行了检索，以查找 1985 年至 2001 年（含）期间以英文发表的对照试验，最好是随机试验。根据设定的标准定位并评分 30 项研究，并对干预措施的研究质量和临床意义进行判断。环境：家庭或非机构环境。参与者：非正式 CG - 在家或非机构环境中提供无偿护理的人员。测量：主要测量是心理发病率和负担。其他不同的结局指标，如 CG 应对技巧和社会支持，与心理困扰和负担的指标相结合，形成了主要的结局指标。结果：17 年来，研究质量有所提高。 30 项研究（34 项干预措施）的结果表明，在最近的随访中，看护者心理困扰（随机效应大小 (ES) = 0.31；95% 置信区间 (CI) = 0.13-0.50）、看护者知识（ES = 0.51；CI = 0.05-0.98）、任何主要看护者结果指标（ES = 0.32；CI = 0.15-0.48）和患者情绪 （ES = 0.68；CI = 0.30-1.06），但不是看护者负担（ES = 0.09；CI = -0.09-0.26）。结果存在相当大的差异，部分原因是方法和干预技术的差异。可以确定成功干预措施的要素。如果除了 CG 之外，还有患者参与，成功的可能性就更大。七项研究中有四项表明延迟入住疗养院。结论：一些 CG 干预措施可以降低 CG 心理发病率，并帮助痴呆症患者在家里呆更长时间。让患者及其家人参与、更加深入并根据 CG 的需求进行修改的计划可能会更成功。未来的研究应该努力提高临床医生制定干预措施的能力。
OBJECTIVES: To review published reports of interventions for caregivers (CGs) of persons with dementia, excluding respite care, and provide recommendations to clinicians.DESIGN: Meta-analytical review. Electronic databases and key articles were searched for controlled trials, preferably randomized, published in English from 1985 to 2001 inclusive. Thirty studies were located and scored according to set criteria, and the interventions' research quality and clinical significance were judged.SETTING: Home or noninstitutional environment.PARTICIPANTS: Informal CGs-persons providing unpaid care at home or in a noninstitutional setting.MEASUREMENTS: The primary measures were psychological morbidity and burden. Other varied outcome measures such as CG coping skills and social support were combined with measures of psychological distress and burden to form a main outcome measure.RESULTS: The quality of research increased over the 17 years. Results from 30 studies (34 interventions) indicated, at most-current follow-up, significant benefits in caregiver psychological distress (random effect size (ES) = 0.31; 95% confidence interval (CI) = 0.13-0.50), caregiver knowledge (ES = 0.51; CI = 0.05-0.98), any main caregiver outcome measure (ES = 0.32; CI = 0.15-0.48), and patient mood (ES = 0.68; CI = 0.30-1.06), but not caregiver burden (ES = 0.09; CI = -0.09-0.26). There was considerable variability in outcome, partly because of differences in methodology and intervention technique. Elements of successful interventions could be identified. Success was more likely if, in addition to CGs, patients were involved. Four of seven studies indicated delayed nursing home admission.CONCLUSION: Some CG interventions can reduce CG psychological morbidity and help people with dementia stay at home longer. Programs that involve the patients and their families and are more intensive and modified to CGs' needs may be more successful. Future research should try to improve clinicians' abilities to prescribe interventions.