Health Care Team Interventions to Reduce Distress Behaviors in Older Adults: A Systematic Review.

IF 2.6 3区医学 Q3 GERIATRICS & GERONTOLOGY

Clinical Gerontologist Pub Date : 2024-10-01 Epub Date: 2024-07-02 DOI:10.1080/07317115.2024.2372424

Katherine Ramos, Megan Shepherd-Banigan, Cara McDermott, Eleanor S McConnell, Sudha R Raman, Dazhe Chen, Tatyana Der, Amir Alishahi Tabriz, Joel C Boggan, Nathan A Boucher, Scott M Carlson, Letha Joseph, Catherine A Sims, Jessica E Ma, Adelaide M Gordon, Paul Dennis, Julee Snyder, Morgan Jacobs, Sarah Cantrell, Jennifer M Gierisch, Karen M Goldstein

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引用次数: 0

Abstract

Objectives: This review examines health care team-focused interventions on managing persistent or recurrent distress behaviors among older adults in long-term residential or inpatient health care settings.

Methods: We searched interventions addressing health care worker (HCW) knowledge and skills related to distress behavior management using Ovid MEDLINE, Elsevier Embase, and Ovid PsycINFO from December 2002 through December 2022.

Results: We screened 6,582 articles; 29 randomized trials met inclusion criteria. Three studies on patient-facing HCW interactions (e.g. medication management, diagnosing distress) showed mixed results on agitation; one study found no effect on quality of life. Six HCW-focused studies suggested short-term reduction in distress behaviors. Quality-of-life improvement or decreased antipsychotic use was not evidenced. Among 17 interventions combining HCW-focused and patient-facing activities, 0 showed significant distress reduction, 8 showed significant antipsychotic reduction (OR = 0.79, 95%CI [0.69, 0.91]) and 9 showed quality of life improvements (SMD = 0.71, 95%CI [0.39, 1.04]). One study evaluating HCW, patient-, and environmental-focused intervention activities showed short-term improvement in agitation.

Conclusions and clinical implications: Novel health care models combining HCW training and patient management improve patient quality of life, reduce antipsychotic use, and may reduce distress behaviors. Evaluation of intervention's effects on staff burnout and utilization is needed.

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医疗团队减少老年人压力行为的干预措施：系统回顾。

目的：本综述研究了以医疗团队为重点的干预措施，以管理长期住院或住院医疗机构中老年人的持续或反复困扰行为：本综述研究了以医护团队为重点的干预措施，这些干预措施旨在管理长期住院或住院医护环境中老年人持续或反复出现的困扰行为：我们使用 Ovid MEDLINE、Elsevier Embase 和 Ovid PsycINFO 检索了 2002 年 12 月至 2022 年 12 月期间针对医护人员（HCW）与困扰行为管理相关的知识和技能的干预措施：我们筛选了 6582 篇文章，其中 29 项随机试验符合纳入标准。三项关于面向患者的医护人员互动（如药物管理、窘迫诊断）的研究对躁动的影响结果不一；一项研究发现对生活质量没有影响。六项以医护人员为重点的研究表明，患者的窘迫行为在短期内有所减少。生活质量的改善或抗精神病药物用量的减少并未得到证实。在 17 项将以人机交互为重点的活动与面向患者的活动相结合的干预措施中，有 0 项显示困扰行为显著减少，8 项显示抗精神病药物显著减少（OR = 0.79，95%CI [0.69，0.91]），9 项显示生活质量有所改善（SMD = 0.71，95%CI [0.39，1.04]）。一项评估以医护人员、患者和环境为重点的干预活动的研究显示，躁动得到了短期改善：将医护人员培训与患者管理相结合的新型医疗保健模式可提高患者的生活质量，减少抗精神病药物的使用，并可减少患者的痛苦行为。需要评估干预措施对员工职业倦怠和使用率的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Gerontologist GERIATRICS & GERONTOLOGY-PSYCHIATRY

CiteScore

6.20

自引率

25.00%

发文量

审稿时长

>12 weeks

期刊介绍： Clinical Gerontologist presents original research, reviews, and clinical comments relevant to the needs of behavioral health professionals and all practitioners who work with older adults. Published in cooperation with Psychologists in Long Term Care, the journal is designed for psychologists, physicians, nurses, social workers, counselors (family, pastoral, and vocational), and other health professionals who address behavioral health concerns found in later life, including: -adjustments to changing roles- issues related to diversity and aging- family caregiving- spirituality- cognitive and psychosocial assessment- depression, anxiety, and PTSD- Alzheimer’s disease and other neurocognitive disorders- long term care- behavioral medicine in aging- rehabilitation and education for older adults. Each issue provides insightful articles on current topics. Submissions are peer reviewed by content experts and selected for both scholarship and relevance to the practitioner to ensure that the articles are among the best in the field. Authors report original research and conceptual reviews. A unique column in Clinical Gerontologist is “Clinical Comments." This section features brief observations and specific suggestions from practitioners which avoid elaborate research designs or long reference lists. This section is a unique opportunity for you to learn about the valuable clinical work of your peers in a short, concise format.