The Effect of Elderly Care and Medical Services Integration Model on Quality of Life in Elderly People：a Meta-analysis

doi:10.12114/j.issn.1007-9572.2019.00.009

Abstract

Abstract: Background　According to the latest world population aging data released by the United Nations Population Division，the proportion of people aged over 60 years has risen from 8.5% in 1980 to 12.7% in 2017，which is expected to double by 2050. In China，the population aged 60 years and over accounts for 16.2% in 2017，which is estimated to reach 35.1% in 2050，posing a extremely grim aging trend. To achieve healthy aging，China has proposed a model of combination of elderly care and medical services. However，compared with the abundant and mature old-age care models in western developed countries，the benefit and content of the combination of medical and health care model should be further verified and improved. Objective　Domestic and foreign randomized controlled trials （RCT） on the effect of elderly care and medical services integration model were systemically retrieved to evaluate its effect on improving the quality of life among the elderly，so as to provide reliable reference for the exploration and development of elderly care and medical services integration model. Methods　The systematic evaluation method provided by Cochrane Collaboration Network was used systemically and comprehensively to retrieve databases，including Cochrane Library，Web of knowledge，Medline，EMBase，Chinese Biological Medical Literature Database （CBM），CNKI，Wanfang Data Knowledge Service Platform，and VIP．Meanwhile，references cited in literature were also screened，and relevant periodicals and gray literature were manually retrieved until 30th December，2017，so as to enroll RCT on providing elderly care and medical services integration model for the elderly. The methodological quality of enrolled literature was evaluated by two reviewers independently using Cochrane Interventions Systematic Review Manual，and the RevMan 5.3 software was used for meta-analyses. Results　A total of 15 studies involving 2 958 subjects were enrolled. According to the Cochrane evaluation tool，two of them were of grade B，and thirteen were of grade C. Results of meta-analysis suggested that PF score，RP score，BP score，GH score，VT score，SF score，RE score，MH score and ADL score in intervention group were higher than those in control group〔MD=7.07，95%CI （4.89，9.25），P<0.000 01；MD=11.73，95%CI （6.98，16.48），P<0.000 01；MD=6.69，95%CI （0.26，13.12），P=0.04；MD=6.38，95%CI （3.13，9.62），P=0.000 1；MD=6.51，95%CI （3.62，9.40），P<0.000 01；MD=6.59，95%CI （4.08，9.10），P<0.000 01；MD=6.64，95%CI （2.19，11.09），P=0.003；MD=5.21，95%CI （1.35，9.08），P=0.008；MD=1.95，95%CI （0.16，3.73），P=0.03〕. Besides，difference in the CES-D score and MMSE score between intervention group and control group were not statistically significant〔MD=-0.93，95%CI （-3.07，1.21），P=0.40；MD=0.18，95%CI （-0.55，0.92），P=0.63〕. Moreover，the meta-analysis results were relatively stable by changing the effect model of meta-analysis and removing high-weight literature. Conclusion　Existing clinical researches have proven that elderly care and medical services integration model is more effective than traditional care in terms of improving the quality of life in elderly people. However，due to late development of this model in China and low quality and small sample size of existing research，more high-quality studies are needed for further research and exploration.

Key words: Combination of medical treatment and maintenance, Aged, Randomized controlled trial, Quality of life, Meta-analysis

摘要： 背景　据联合国人口司最新公布的世界人口老龄化数据显示，60岁及以上人口从1980年的8.5%上升到2017年的12.7%，预计到2050年此数量将再增加1倍，而中国地区2017年60岁及以上人口占16.2%，预计2050年将达到35.1%，老龄化形式十分严峻。为实现健康老龄化，我国提出发展“医养结合”养老模式，但相比西方发达国家丰富成熟的养老模式，“医养结合”养老模式的优越性及内容建设尚需进一步验证和完善。目的　通过全面检索国内外关于“医养结合”照护模式对老年人生活质量影响的随机对照试验（RCT），进一步评价其改善老年人生活质量的效果，以期为“医养结合”照护模式的探索及发展提供可靠的依据。方法　使用Cochrane协作网提供的系统评价方法，系统全面检索Cochrane Library、Web of Knowledge、Medline、EMBase、中国生物医学文献数据库（CBM）、中国知网、万方数据知识服务平台、维普网（VIP）等数据库。同时筛查纳入文献的参考文献，结合手工检索相关期刊及灰色文献，检索时间截至2017-12-30，纳入为老年人提供“医养结合”照护模式的RCT。由两名评价者采用Cochrane干预措施系统评价手册共同评价纳入文献的方法学质量，采用RevMan 5.3软件进行Meta分析。结果　共纳入15篇文献，包括2 958例研究对象。根据Cochrane评估工具，2篇为B级，13篇为C级。Meta分析结果显示，试验组生理机能（PF）评分、生理职能（RP）评分、躯体疼痛（BP）评分、一般健康状况（GH）评分、精力（VT）评分、社会功能（SF）评分、情感职能（RE）评分、精神健康（MH）评分、日常生活活动能力量表（ADL）评分均高于对照组〔均数差（MD）=7.07，95%CI（4.89，9.25），P<0.000 01；MD=11.73，95%CI（6.98，16.48），P<0.000 01；MD=6.69，95%CI（0.26，13.12），P=0.04；MD=6.38，95%CI（3.13，9.62），P=0.000 1；MD=6.51，95%CI（3.62，9.40），P<0.000 01；MD=6.59，95%CI（4.08，9.10），P<0.000 01；MD=6.64，95%CI（2.19，11.09），P=0.003；MD=5.21，95%CI（1.35，9.08），P=0.008；MD=1.95，95%CI（0.16，3.73），P=0.03〕。试验组和对照组流调用抑郁自评量表（CES-D）评分、简易精神状态检查量表（MMSE）评分比较，差异均无统计学意义〔MD=-0.93，95%CI（-3.07，1.21），P=0.40；MD=0.18，95%CI（-0.55，0.92），P=0.63〕。通过改变Meta分析效应量模型，以及删除高权重文献后，Meta分析结果比较稳定，未发生变化。结论　现有临床研究证据证明，“医养结合”照护模式在改善老年人生存质量上较常规照护模式更有效，但鉴于“医养结合”照护模式在我国起步晚、发展慢，现有研究质量不高以及样本量较小等，还需要更多高质量的研究进一步的研究和探索。

关键词: 医养结合, 老年人, 随机对照试验, 生活质量, Meta分析

LUO Jing,LIU Yao,LUO Yuru, et al. The Effect of Elderly Care and Medical Services Integration Model on Quality of Life in Elderly People：a Meta-analysis　[J]. Chinese General Practice, 2019, 22(17): 2075-2083. DOI: 10.12114/j.issn.1007-9572.2019.00.009.
罗婧,刘瑶,罗玉茹等. 医养结合照护模式对老年人健康相关生存质量影响的Meta分析[J]. 中国全科医学, 2019, 22(17): 2075-2083. DOI: 10.12114/j.issn.1007-9572.2019.00.009.

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