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Personal assistance for older adults (65+) without dementia

  • Review
  • Intervention

Authors


Abstract

Background

There is a high prevalence of impairments among people 65+, and the elderly population is increasing in the West. Many countries offer personal assistance, individualised support for people living in the community by a paid assistant other than a healthcare professional for at least 20 hours per week.

Objectives

To assess the effectiveness of personal assistance for older adults with impairments, and the impacts of personal assistance on others, compared to other interventions.

Search methods

Electronic databases including CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Dissertation Abstracts International and a variety of specialist Swedish databases were searched from 1980 to June 2005; reference lists were checked; 345 experts, organisations, government bodies and charities were contacted in an attempt to locate relevant research.

Selection criteria

This review included older adults (65+) living in the community who require assistance to perform tasks of daily living (e.g., bathing and eating) and participate in normal activities due to permanent impairments. Controlled studies of personal assistance in which participants were prospectively assigned to study groups and in which control group outcomes were measured concurrently with intervention group outcomes were included.

Data collection and analysis

Titles and abstracts were examined by two reviewers. Outcomes data were extracted. Because they made different comparisons, studies were not combined for meta-analyses. Studies were assessed for the possibility of bias. Results and potential sources of bias are presented for included studies.

Main results

Four studies involving 1642 participants made three eligible comparisons: (i) personal assistance versus usual care, (ii) personal assistance versus nursing homes, and (iii) personal assistance versus 'cluster care'. One was an RCT, three were non-randomised. Personal assistance was generally preferred over other services; however, some people prefer other models of care. This review indicates that personal assistance probably has some benefits for some recipients and caregivers. Paid assistance probably substitutes for informal care and may cost government more than alternatives; however, the total costs to recipients and society are currently unknown.

Authors' conclusions

Research in this field is limited. Personal assistance is expensive and difficult to organise, especially in places that do not already have services in place. When implementing new programmes, recipients could be randomly assigned to different forms of assistance. While advocates may support personal assistance for myriad reasons, this review demonstrates that further studies are required to determine which models of personal assistance are most effective and efficient.

摘要

背景

對於大於65歲,沒有失智症的老人的個人協助

在大於65歲的老人中,有相當高的失能盛行率,而且在西方社會中,老人的人口正在增加。有許多國家對居住在社區中的老人,提供個人協助,藉由每星期至少20個小時支薪看護,而非專業的健康照護者,來給予個人化的支持。

目標

評估給予失能老人個人協助的效果,以及對於旁人的影響,並和其他介入方法作比較。

搜尋策略

搜尋在1980年至2005年6月,下列電子資料庫的資料:CENTRAL, MEDLINE,EMBASE,CINAHL,PsycINFO,ERIC,Dissertation Abstracts International和各式各樣的專業瑞典資料庫;檢查相關文獻的名單;並聯絡共345位專家、組織、政府機關來確認這些相關文獻研究。

選擇標準

這篇回顧的對象包括居住在社區中,年齡大於65歲且需要協助日常生活 (比如洗澡和進食) 及協助參加一般性活動的老人。在進行個人協助議題的前瞻性對照試驗時將參與者地分配到研究組或對照組,隨後同時去比對兩組於介入治療後的預後。

資料收集與分析

由兩位回顧者來檢視文獻標題和摘要取得預後的資料。因為各文獻的比較的預後內容不一,這些文獻並沒有合併起來做統合分析。評估研究偏差 (bias) 的可能性。結果和可能的偏差來源也需呈現。

主要結論

從4篇試驗、共1642名參與者得到了3個合適的比較:1、個人協助與一般照顧,2、個人協助與安養中心,3、個人協助與集體看護 (cluster care) 。其中1篇試驗為隨機對照試驗 (RCT) ,另外3篇為非隨機的。和其他種類的介入比較起來,個人協助之結果比較好。我們的回顧結論指出,個人協助化可能對接受者和照顧者都有一些好處。支薪看護可能替代了非正式的照護,但可能會造成政府機關更大的花費開銷。然而,目前並無法得知接受者和社會的總開銷。

作者結論

這個領域的相關研究有其侷限性。個人化協助是昂貴且難以去組織的,特別是在那些尚未有此類服務的地方。當開始新計畫的實行時,參與者可以被隨機的分配接受不同種類的協助。雖然擁護者會以各式各樣的理由來支持個人化協助的模式,這篇回顧也顯示了,為了得知何種類型的個人化協助有最好的效果和效率,更進一步的相關研究是需要的。

翻譯人

本摘要由成功大學附設醫院紀美宏翻譯。

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

總結

個人化協助為對失能老年人每星期至少20小時的付費性支持。這篇回顧探討對老年人 (大於65歲) 個人化協助和其他種類的照顧方法,在有效性方面的比較。有一個文獻搜尋辨識出四個符合搜納條件的試驗,總共包括1642個參與者。結果建議,個人化協助比其他照顧方法,要來的更為被偏好;然而,某些人會比較喜歡其它的照護模式。這篇回顧指出,個人化協助可能可以為某些參與者和他們的照顧者帶來益處。付費的協助,可能可以替代正式的照顧單位,且花費的管理優於其他種類的安排。對於參與者和社會來說,相對的總花費開銷還是未知的。

Plain language summary

Personal assistance for older adults without dementia

Personal assistance is paid support of at least 20 hours per week for people with impairments. This review investigated the effectiveness of personal assistance versus any other form of care for older adults (65+). An exhaustive literature search identified 4 studies that met the inclusion criteria, which included 1642 participants. They suggested that personal assistance may be preferred over other services; however, some people prefer other models of care. This review indicates that personal assistance probably has some benefits for some recipients and their informal caregivers. Paid assistance might substitute for informal care and cost government more than alternative arrangements; however, the relative total costs to recipients and society are unknown.

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