Integrated Physical-Mental Healthcare Services in Specialist Settings to Improve Outcomes for Older People Living With Mental Health Diagnoses: A Systematic Review

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry Pub Date : 2024-09-12 DOI:10.1002/gps.6146

Lucy Beishon, Bethan Hickey, Bhavisha Desai, Tamara Chithiramohan, Rachel Evley, Hari Subramaniam, Gregory Maniatopoulos, Anto P. Rajkumar, Tom Dening, Elizabeta Mukateova-Ladinska, Thompson G. Robinson, Carolyn Tarrant

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Abstract

Background

Many older people are now living with co-occurring physical and mental health disorders, but these often managed separately. The aim of this systematic review was to explore integrated physical-mental health care services available internationally for older people living with mental health diagnoses, and whether these result in improved health outcomes.

Methods

Medline, Embase, CINAHL, PsycINFO and Scopus were searched with a predefined search strategy (PROSPERO: CRD42022383824), generating 6210 articles. Studies were included where an integrated physical-mental health care service model was utilised in a population of older people (aged >60 years) with a mental health diagnosis (including dementia or cognitive impairment) and at least one concomitant physical health condition requiring physical health care input. All studies were assessed for risk of bias (ROB 2.0, ROBINS-I) and results were synthesised narratively.

Results

Nine studies were included across inpatient (n = 6, 1262 patients) and community (n = 3, 466 patients) settings. Studies were rated as low-moderate risk of bias. These covered joint physical-mental health wards, liaison services, embedded physicians in mental health wards, and joint multidisciplinary teams. Services with greater integration (e.g., joint wards) had more benefits for patients and carers. There were few benefits to traditional outcomes (e.g., hospital admissions, mortality), but greater care quality, carer satisfaction, and improved mood and engagement were demonstrated.

Conclusions

Multidisciplinary integrated care resulted in improvement of a range of health outcomes for older people with combined physical and mental health needs. Larger and more robust studies are needed to explore the development of these service models further, with cost-effectiveness analyses.

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在专业机构中提供身心综合保健服务，以改善患有精神疾病的老年人的生活质量：系统性综述

背景目前，许多老年人同时患有身体和精神疾病，但这些疾病通常是分开管理的。本系统性综述旨在探讨国际上为患有精神疾病的老年人提供的综合身体和心理健康护理服务，以及这些服务是否能改善健康状况。方法采用预先确定的检索策略（PROSPERO：CRD42022383824）对 Medline、Embase、CINAHL、PsycINFO 和 Scopus 进行检索，共检索到 6210 篇文章。纳入的研究都是针对被诊断患有精神疾病（包括痴呆症或认知障碍）并同时患有至少一种需要物理治疗的躯体疾病的老年人（年龄在 60 岁以上）采用的综合物理治疗-心理治疗服务模式。对所有研究进行了偏倚风险评估（ROB 2.0，ROBINS-I），并对结果进行了叙述性综合。结果共纳入九项研究，涉及住院环境（n = 6，1262 名患者）和社区环境（n = 3，466 名患者）。研究的偏倚风险被评为中低。这些研究涵盖了联合躯体和精神健康病房、联络服务、精神健康病房的嵌入式医生以及联合多学科团队。整合程度更高的服务（如联合病房）对患者和护理者的益处更大。传统的治疗结果（如入院率、死亡率）几乎没有什么益处，但护理质量、护理者满意度以及情绪和参与度都有所提高。结论多学科综合护理改善了合并有身心健康需求的老年人的一系列健康结果。需要开展更大规模、更有力的研究，进一步探索这些服务模式的发展，并进行成本效益分析。

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来源期刊

International Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

6.10

自引率

2.50%

发文量

168

审稿时长

4-8 weeks

期刊介绍： The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers. The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.