Care home versus hospital and own home environments for rehabilitation of older people

 

Abstract

Background

Rehabilitation for older people has acquired an increasingly important profile for both policy-makers and service providers within health and social care agencies. This has generated an increased interest in the use of alternative care environments including care home environments. Yet, there appears to be limited evidence on which to base decisions.

This review is the first update of the Cochrane review which was published in 2003.

Objectives

To compare the effects of care home environments (e.g. nursing home, residential care home and nursing facilities) versus hospital environments and own home environments in the rehabilitation of older people.

Search methods

We searched the Cochrane Effective Practice and Organisation of Care Specialised Register and Pending Folder, MEDLINE (1950 to March Week 3 2007), EMBASE (1980 to 2007 Week 13), CINAHL (1982 to March, Week 4, 2007), other databases and reference lists of relevant review articles were additionally reviewed. Date of most recent search: March 2007.

Selection criteria

Randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series (ITS) that compared rehabilitation outcomes for persons 60 years or older who received rehabilitation whilst residing in a care home with those who received rehabilitation in hospital or own home environments.

Data collection and analysis

Two review authors independently assessed trial quality and extracted data.

Main results

In this update, 8365 references were retrieved. Of these, 339 abstracts were independently assessed by 2 review authors, and 56 studies and 5 review articles were subsequently obtained. Full text papers were independently assessed by two or three review authors and none of these met inclusion criteria.

Authors' conclusions

There is insufficient evidence to compare the effects of care home environments versus hospital environments or own home environments on older persons rehabilitation outcomes. Although the authors acknowledge that absence of effect is not no effect. There are three main reasons; the first is that the description and specification of the environment is often not clear; secondly, the components of the rehabilitation system within the given environments are not adequately specified and; thirdly, when the components are clearly specified they demonstrate that the control and intervention sites are not comparable with respect to the methodological criteria specified by Cochrane EPOC group. The combined effect of these factors resulted in the comparability between intervention and control groups being very weak.

 

Plain language summary

Location of rehabilitation services for the elderly

For a number of reasons, there has been an increased interest in providing elderly people with appropriate rehabilitation services.  Not only are there more elderly people, but the importance of ‘rehab’ after a stroke, hip fracture, or an illness in general, has been recognised.  With this, is the increasing pressure to use health care resources efficiently, ensure hospital beds are available to people who need acute hospital care and that rehab facilities and community services are in place. 

To ensure that elderly people can receive rehabilitation services, different ways of providing rehab have been developed.  An important difference in the services is where the rehab takes place.  Some services take place in care home environments, such as nursing homes, residential care homes and nursing facilities, while other services can take place in the hospital or at home.   

To determine and compare the effects of the different places for rehab on elderly people, a review was conducted.  After searching for all possible relevant studies, no studies were found.  Studies are needed.

 

摘要

背景

比較居家護理對醫院及自己的家庭環境對老年人康復的影響

老年人的康復對於在健康和社會照護機構內的決策者和服務提供者已經有越來越重要的現象。因為這樣讓我們對使用包括居家護理環境等照護環境的選擇，產生了更多的關注。然而，在做根本決定時之實證資料有限。這評論是在2003年發表Cochrane之評論的第一次更新。

目標

比較居家護理環境(例如護理之家、居住的照護家庭及護理機構)對醫院環境及自己的家庭環境，對老年人康復的影響。

搜尋策略

我們搜尋登錄在Cochrane有效實務及專業照護組織及懸而未決的資料、MEDLINE (1950到2007年3月第3週)、EMBASE (1980年到2007年13週)、 CINAHL (1982 年到2007年3月第4週)、其他資料庫及相關評論文章的文獻目錄。最後搜尋的日期為2007年3月。

選擇標準

隨機對照試驗(Randomised controlled trials, RCTs)、臨床對照試驗(controlled clinical trials, CCTs)、前後對照研究(controlled before and after studies, CBAs)及干涉時間序列研究(interrupted time series, ITS)，比較60歲及以上老年人居住在護理之家、在醫院或自己的家庭環境接受復健的康復結果。

資料收集與分析

兩位評論家獨立的評估試驗品質及摘取資料。

主要結論

在更新的資料中，檢索得到8365篇文獻。這些文獻中，339篇摘要由兩位評論作者獨立的評估，之後得到56篇研究及5篇評論文章(review articles)。全文文章由兩位或三位評論作者獨立的評估，沒有一篇符合納入標準。

作者結論

沒有充分的證據去比較在居家環境對在醫院環境或自己的家庭環境，對老年人復原結果的效果。作者認為缺乏效果不代表沒有效果。有三項主要的原因，第一，對環境的描述及說明常常是不清楚的；第二，對所給予的環境中，修復系統的要素沒有適當的明確說明；第三，當具備的要素清楚說明後，他們表示遵守由Cochrane EPOC團體明訂的方法學上的標準，對照及介入組的場所無法比較。總結這些因素，造成在介入及對照組間的可比較性變得非常微弱。

翻譯人

本摘要由高雄榮民總醫院林麗英翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

老年人對復健照護的需求日益增多，增加了替代性照護環境的使用興趣。此篇評論評估是否恢復的地點對改善健康是重要的。研究中比較在護理之家環境(例如護理之家、居住的照護家庭及護理機構)對在醫院的環境及自己的家庭環境，對老年人恢復的影響。此篇評論沒有看到符合納入標準的研究。因證據不足阻礙本評論作者比較照護環境的效果。在可以描述有關護理居家環境比對醫院的和自己的家庭環境對老年人康復的影響的結論之前，需要更多精確的研究。