Christina Hayes, Amanuel Yigezu, Sarah Dillon, Christine Fitzgerald, Molly Manning, Aoife Leahy, Dominic Trépel, Katie Robinson, Rose Galvin
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引用次数: 0
摘要
背景：综合老年评估（CGA）是一种综合护理的运作模式，已成为老年人医疗保健服务模式的基本组成部分。这是一个多方面的诊断过程，旨在确定体弱老年人的医疗、社会心理和功能能力和局限性，以制定综合护理计划。本系统回顾和荟萃分析的目的是更新和综合有关家庭CGA与常规护理在社区居住的高危老年人中的有效性的研究证据。本综述的第二个目的是表征在纳入的研究中传递的CGA成分。方法：检索CENTRAL、MEDLINE、Embase、CINAHL、试验注册库（WHO ICTRP、ClinicalTrials.gov和McMaster Aging Portal）和灰色文献。两名独立审稿人进行了筛选、数据提取、质量评估，并应用了建议分级、评估、发展和评估框架来量化证据的确定性。meta分析在Review Manager 5.4中进行。主要结果是功能状态。结果：纳入22项试验，招募7219名社区居住老年人。以家庭为基础的CGA在6-24个月（标准化平均差[SMD] 0.17, 95%可信区间[CI] 0.09-0.25）、12个月（SMD 0.24, 95% CI 0.02-0.47）和24个月（SMD 0.11, 95% CI 0.01-0.22）时改善了功能状态；6-24个月和12个月时健康相关生活质量（HRQoL）增加；36个月死亡率降低；6-36个月住院次数减少；提高了患者6-12个月的护理满意度。以家庭为基础的CGA在疗养院入院、急诊科表现或不良事件方面几乎没有差异。不同试验的干预特征和多学科团队组成各不相同。结论：以家庭为基础的CGA改善了社区居住风险老年人的临床和过程结果。综合多学科团队提供的CGA提高了社区居住老年人的功能状态。
Home-Based Comprehensive Geriatric Assessment for Community-Dwelling, At-Risk, Frail Older Adults: A Systematic Review and Meta-Analysis
Background
Comprehensive geriatric assessment (CGA), an operational model of integrated care, has become a fundamental component of healthcare delivery models for older adults. It is a multidimensional diagnostic process intended to determine a frail elderly person's medical, psychosocial, and functional capabilities and limitations to develop an integrated care plan. The aim of this systematic review and meta-analysis was to update and synthesize the totality of research evidence related to the effectiveness of home-based CGA compared with usual care among community-dwelling at-risk older adults. A secondary aim of the review was to characterize the components of CGA delivered across the included studies.
Methods
CENTRAL, MEDLINE, Embase, CINAHL, trial registers (WHO ICTRP, ClinicalTrials.gov, and McMaster Aging Portal), and gray literature were searched. Two independent reviewers conducted screening, data extraction, quality appraisal, and applied the Grading of Recommendations, Assessment, Development, and Evaluations framework to quantify the certainty of evidence. Meta-analyses were performed in Review Manager 5.4. The primary outcome was functional status.
Results
Twenty-two trials recruiting 7219 community-dwelling older adults were included. Home-based CGA resulted in improved functional status at 6–24 months (standardized mean difference [SMD] 0.17, 95% confidence interval [CI] 0.09–0.25), at 12 months (SMD 0.24, 95% CI 0.02–0.47), and at 24 months (SMD 0.11, 95% CI 0.01–0.22); an increased health-related quality of life (HRQoL) at 6–24 and 12 months; a reduction in mortality at 36 months; a reduction in hospitalizations at 6–36 months; and improved patient satisfaction with care at 6–12 months. Home-based CGA resulted in little or no difference in nursing home admission, emergency department presentation, or adverse events. Intervention characteristics and multidisciplinary team composition varied across trials.
Conclusion
Home-based CGA improves clinical and process outcomes for community dwelling at-risk older adults. CGA delivered by a comprehensive multidisciplinary team enhances functional status among community-dwelling older adults.
期刊介绍：
Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.
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