长期照护机构老年人综合评估工具研究进展及系统评价
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摘要
背景目前国内外的老年人综合评估工具较多,但我国养老机构的照护服务质量参差不齐,尚缺乏统一的老年人能力评估工具。目的系统评价国内外老年人综合评估工具的信效度并结合我国国情进行分析,以选择适合我国长期照护机构老年人综合评估的工具。方法于2018年1—6月,计算机检索中国知网、万方数据知识服务平台以及Scopus、PubMed、Usearch、CINAHL、PsycINFO、Medline数据库中与老年人综合评估有关的文献(发表时间为2008—2018年),以获取老年人综合评估工具及相关资料。采用"基于共识选择健康测量工具的标准"(COSMIN)评估合格文献中老年人综合评估工具的方法学质量。结果最终纳入合格文献21篇,涉及老年人综合评估工具9种,仅5种工具被汇报了信效度相关信息。根据COSMIN:国际居民长期照护评估工具(interRAI-LTCF)的内部一致性等级评定为一般,3篇文献中汇报的重测信度等级分别评定为差、一般、一般;诺丁汉健康量表(NHP)的内部一致性、重测信度等级评定为差;重庆市医院-养老机构-社区通用老年人健康综合评估量表(BGA)的效度和信度等级均被评定为差;老年人能力评估问卷的内部一致性等级评定为一般;老年人健康功能综合评价量表的内部一致性、内部效度、结构效度等级评定为差。结论 interRAI-LTCF和老年人能力评估问卷是未来值得在我国长期照护机构中进行推广的老年人综合评估工具,但仍需更多高质量的将评估工具应用于长期照护机构的研究来测量其信效度和可行性。
Background There are many comprehensive geriatric assessment(CGA) tools at home and abroad,but there are no unified CGA tools for older people in long-term care facilities(LTCF) delivering different qualities of care in China.Objective To review systematically the psychometric properties of CGA tools in LTCF and choose the appropriate ones for LTCF in China.Methods From January to June 2018,we performed an analysis of the data for CGA in LTCF published from 2008 to 2018 that were retrieved from eight databases:CNKI,Wanfang,Scopus,PubMed,Usearch,CINAHL,PsycINFO and Medline.The COSMIN checklist was used to assess the methodological quality of the eligible studies.Results Altogether,21 papers were included.Of the papers,there were 9 kinds of CGA instruments,but only 5 instruments' psychometric properties were reported.By use of the COSMIN checklist,the internal consistency of interRAI-LTCF was rated as fair,and its retest reliability was rated as poor,fair,and fair in 3 studies,respectively.The internal consistency and retest reliability of Nottingham Health Profile was evaluated as poor.Both the validity and reliability of BGA used in Chongqing's hospitals,elderly care facilities and community-based healthcare institutions were assessed as poor.The internal consistency of Ability Assessment for Older Adults was assessed as fair.The internal consistency,content validity and construct validity of Elderly Comprehensive Health Assessment Scale were assessed as poor.Conclusion Both the interRAI-LTCF and the Ability Assessment for Older Adults are worth promoting in LTCF in China,but their psychometric properties and feasibilities need to be tested by more high-quality studies.
Background There are many comprehensive geriatric assessment(CGA) tools at home and abroad,but there are no unified CGA tools for older people in long-term care facilities(LTCF) delivering different qualities of care in China.Objective To review systematically the psychometric properties of CGA tools in LTCF and choose the appropriate ones for LTCF in China.Methods From January to June 2018,we performed an analysis of the data for CGA in LTCF published from 2008 to 2018 that were retrieved from eight databases:CNKI,Wanfang,Scopus,PubMed,Usearch,CINAHL,PsycINFO and Medline.The COSMIN checklist was used to assess the methodological quality of the eligible studies.Results Altogether,21 papers were included.Of the papers,there were 9 kinds of CGA instruments,but only 5 instruments' psychometric properties were reported.By use of the COSMIN checklist,the internal consistency of interRAI-LTCF was rated as fair,and its retest reliability was rated as poor,fair,and fair in 3 studies,respectively.The internal consistency and retest reliability of Nottingham Health Profile was evaluated as poor.Both the validity and reliability of BGA used in Chongqing's hospitals,elderly care facilities and community-based healthcare institutions were assessed as poor.The internal consistency of Ability Assessment for Older Adults was assessed as fair.The internal consistency,content validity and construct validity of Elderly Comprehensive Health Assessment Scale were assessed as poor.Conclusion Both the interRAI-LTCF and the Ability Assessment for Older Adults are worth promoting in LTCF in China,but their psychometric properties and feasibilities need to be tested by more high-quality studies.
引文
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[2]党俊武.长期照护服务体系是应对未来失能老年人危机的根本出[J].人口与发展,2009,15(4):52-55.DANG J W.Long-term care service system is the fundamental way to cope with the crisis of the elderly disabled in the future[J].Population and Development,2009,15(4):52-55.
[3]PILOTTO A,PANZA F.Comprehensive geriatric assessment:evidence[M]//MICHELJ P,BEATTIE B L,MARTIN F C,et al.Oxford textbook of geriatric medicine.3rd ed.Oxford:Oxford University Press,2017.
[4]LIBERATI A,ALTMAN D G,TETZLAFF J,et al.The PRISMAstatement for reporting systematic reviews and meta-analysis of studies that evaluate healthcare interventios:explanation and elaboration[J].Annuals of Internal Medicine,2009,151(4):66-94.DOI:10.1371/journal.pmed.1000100.
[5]MOKKINK L B,TERWEE C B,STRATFORD P W,et al.Evaluation of the methodological quality of systematic reviews of health status measurement instruments[J].Quality of Life Research,2009,18(3):313-333.
[6]TERWEE C B,MOKKINK L B,KNOL D L,et al.Rating the methodological quality in systematic reviews of studies on measurement properties:a scoring system for the COSMINchecklist[J].Quality of Life Research,2012,21(4):651-657.
[7]谢世麒,周建荣.重庆市医院-养老机构-社区通用老年健康综合评估量表的编制和信效度检验[J].检验医学与临床,2016,13(A02):369-372.XIE S Q,ZHOU J R.Compilation and reliability and validity test of Chongqing Hospital-Retirement Institution-Community General Elderly Health Comprehensive Assessment Scale[J].Lab Med Clin,2016,13(A02):369-372.
[8]郭红艳,王黎,王志稳,等.老年人能力等级划分方式的研究[J].中国护理管理,2013,13(9):35-38.GUO H Y,WANG L,WANG Z W,et al.Exploration research of older adults'ability level division[J].Chinese Nursinng Management,2013,13(9):35-38.
[9]胡秀英,龙纳,陈茜,等.老年人健康功能综合评价量表的研制//中华护理学会.第15届全国老年护理学术交流会议论文汇编,大连,2012.
[10]HIRDES J P,LJUNGGREN G,MORRIS J N,et al.Reliability of the interRAI suite of assessment instruments:a 12-country study of an integrated health information system[J].BMC Health Services Research,2008,8(1):1-11.
[11]KIM H,JUNG Y I,SUNG M,et al.Reliability of the interRAILong Term Care Facilities(LTCF)and interRAI Home Care(HC)[J].Geriatrics&Gerontology International,2015,15(2):220-228.DOI:10.1111/ggi.12330.
[12]ONDER G.Assessment of nursing home residents in Europe:the Services and Health for Elderly in Long Term Care(SHELTER)study[J].BMC Health Services Research,2012,12(1):5.
[13]TABALI M,JESCHKE E,DASSEN T,et al.The Nottingham Health Profile:a feasible questionnaire for nursing home residents?[J].International Psychogeriatrics,2012,24(3):416-424.DOI:10.1017/S1041610211001931.
[14]HJALTADOTTIRH I,HALLBERG I R,EKWALL A K,et al.Predicting mortality of residents at admission to nursing home:a longitudinal cohort study[J].Health Service Research,2011,11:86.
[15]EENOO L V,VESENINI L,VANNESTE D,et al.The involvement of the general practitioner in an interRAI assessment for the care of elderly in Flemish nursing homes and home care:an explorative study[J].International Journal of Integrated Care,2013,13(5):779-800.
[16]ARLING G,KANE R L,COOKE V,et al.Targeting residents for transitions from nursing home to community[J].Health Services Research,2010,45(3):691-711.
[17]BOORSMA M,LANGEDIJK E,FRIJTERS D H,et al.Implementation of geriatric assessment and decision support in residential care homes:facilitating and impeding factors during initial and maintenance phase[J].BMC Health Services Research,2013,13(1):1-9.
[18]CAI S,MUKAMEL D B,VEAZIE P,et al.Validation of the Minimum Data Set in identifying hospitalization events and payment source[J].Journal of the American Medical Directors Association,2011,12(1):38-43.
[19]HOBEN M,POSS J W,NORTON P G,et al.Oral/dental items in the resident assessment instrument-Minimum Data Set 2.0lack validity:results of a retrospective,longitudinal validation study[J].Population Health Metrics,2016,14(1):36.
[20]GINDIN J,Shochat T,Chetrit A,et al.Insomnia in longterm care facilities:a comparison of seven European countries and Israel:the services and health for elderly in Long TERm Care Study[J].Journal of the American Geriatrics Society,2014,62(11):2033.DOI:10.1111/jgs.13099.
[21]LEE J S,CHAU P P,HUI E,et al.Survival prediction in nursing home residents using the Minimum Data Set subscales:ADL SelfPerformance Hierarchy,Cognitive Performance and the Changes in Health,End-stage Disease and Symptoms and Signs scales[J].European Journal of Public Health,2009,19(3):308-312.
[22]ONDER G,LIPEROTI R,RIALOVA D,et al.Polypharmacy in nursing home in Europe:results from the SHELTER Study[J].Journals of Gerontology,2012,67(6):698-704.
[23]SALIBA D,BUCHANAN J.Making the investment count:revision of the Minimum Data Set for nursing homes,MDS 3.0[J].Journal of the American Medical Directors Association,2012,13(7):602-610.
[24]SKEWINGTON S M,LOFTY M,O'CONNELL K A.The World Health Organization's WHOQOL-BREF quality of life assessment:psychometric properties and results of the international field trial.Areport from the WHOQOL Group[J].Qual Life Res,2004,13(2):299-310.
[25]KANWAR A,SINGH M,LENNON R,et al.Frailty and health-related quality of life among residents of long-term care facilities[J].Journal of Aging&Health,2013,25(5):792-802.
[26]WANN-HANSSON C,KLEVSGARD R,HAGELL P.Crossdiagnostic validity of the Nottingham Health Profile Index of Distress(NHPD)[J].Health&Quality of Life Outcomes,2008,6(1):47.
[27]MARSHALL E G,CLARKE B S,VARATHARASAN N,et al.A Long-term Care-Comprehensive Geriatric Assessment(LTC-CGA)tool:improving care for frail older adults?[J].2015,18(1):2-10.DOI:10.5770/cgj.18.122.
[28]MORRIS J N,HAWES C,FRIES B E,et al.Designing the national resident assessment instrument for nursing homes[J].Gerontologist,1990,30(3):293-307.
[29]FRIES B E,SCHROLL M,HAWES C,et al.Approaching cross-national comparisons of nursing home residents[J].Age&Ageing,1997,26(suppl 2):13.
[30]GRAY L C,BERG K,FRIES B E,et al.Sharing clinical information across care settings:the birth of an integrated assessment system[J].BMC Health Services Research,2009,9(1):71.
[31]CARPENTER I,HIRDES J P.Using interRAI assessment systems to measure and maintain quality of long-term care//Monitoring and Improving Quality in Long-term Care OECD/European Commission.A Good Life in Older Age,2013.
[32]BODUR S,CINGILD D.Using WHOQOL-BREF to evaluate quality of life among Turkish elders in different residential environments[J].JNHA,2009,13(7):652-656.
[33]MCHORNEY C A,JR W J,LU J F,et al.The MOS 36-item Short-Form Health Survey(SF-36):Ⅲ.Tests of data quality,scaling assumptions,and reliability across diverse patient groups[J].Medical Care,1994,32(1):40-66.
[34]POST M W,GERRITSEN J,VAN LEUSEN N D,et al.Adapting the Nottingham Health Profile for use in people with severe physical disabilities[J].Clinical Rehabilitation,2001,15(1):103-110.
[35]ROCKWOOD K,ABEYSUNDERA M J,MITNITSKI A.How should we grade frailty in nursing home patients?[J].Journal of the American Medical Directors Association,2007,8(9):595-603.
[36]GAGE B,CONSTATINE R,AGGARWAL J,et al.The development and testing of the Continuity Assessment Record and Evaluation(CARE)item set:final report on the development of the care item set[R].2012:464.
[37]CUI Y,GONG D,YANG B,et al.Making the CAREComprehensive Geriatric Assessment as the core of a total mobile long term care support system in China[J].Studies in Health Technology&Informatics,2018,247:770.DOI:10.3233/978-1-61499-852-5-770.
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