衰弱老年人管理循证指南的质量评价

doi:10.3761/j.issn.0254-1769.2020.02.014

摘要/Abstract

摘要：

目的评价国内外衰弱老年人管理相关的循证指南,分析各指南的特点,为国内开展衰弱老年人管理的实践提供参考。方法系统检索国内外权威指南网站、中英文数据库以及老年学医学专业学会网站中老年人衰弱管理的相关指南,检索时限为建库至2018年10月。采用临床研究与评估工具对符合纳入、排除标准的指南进行质量评价,并分析各指南的特点。结果共检索出3篇循证指南,质量评价的6个领域的平均标准化得分分别为:范围和目的97.5%,参与人员68.5%,严谨性65.3%,清晰性95.7%,应用性68.7%,编辑的独立性61.1%,指南总体质量评价为1篇A级,2篇B级。结论国内外衰弱老年人管理的循证指南数量较少,指南的总体质量有待提高,内容有待细化,国内有待形成本土的循证指南,指导衰弱老年人管理实践的开展。

关键词: 衰弱, 老年人, 指南, 循证护理

Abstract:

Objective To evaluate the evidence-based guidelines for the management of frail elderly at home and abroad,and analyze the characteristics of each guideline,so as to provide references for the management of frail elderly in China. Methods We conducted a systematic retrieval of the relevant guidelines on frailty management of the elderly published or updated since the database was established until October 2018（the deadline for retrieval）,in authoritative domestic and foreign guide websites,Chinese and English databases and the website of the professional society of gerontology and medicine. The 2017 updated version of the clinical research and evaluation tool for quality evaluation of guidelines meeting inclusion and exclusion criteria was used to analyze the characteristics of the guidelines. Results A total of 3 relevant evidence-based guidelines at home and abroad were retrieved. The average standardized scores of quality evaluation for the 6 areas were 97.5% for scope and purpose,68.5% for participants,65.3% for rigor,95.7% for clarity,68.7% for application,and 61.1% for independence. For overall quality,1 was Grade A and 2 were Grade B. Conclusion There is still a lack of evidence-based guidelines for the management of frail elderly at home and abroad,and the quality of developed guidelines needs to be improved,and contents need to be refined. Local evidence-based guidelines in China should be developed to guide the implementation of management of frail elderly.

Key words: Frailty, Aged, Guideline, Evidence-based Nursing

王斗, 丛雪, 周雅静, 关欣, 马睛雅, 张小艳, 李学靖, 曲畅, 郝玉芳. 衰弱老年人管理循证指南的质量评价[J]. 中华护理杂志, 2020, 55(2): 237-242.

WANG Dou, CONG Xue, ZHOU Yajing, GUAN Xin, MA Jingya, ZHANG Xiaoyan, LI Xuejing, QU Chang, HAO Yufang. Quality evaluation of evidence-based guidelines for the management of frail elderly[J]. Chinese Journal of Nursing, 2020, 55(2): 237-242.

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参考文献 24

[1]	中华医学会老年医学分会. 老年患者衰弱评估与干预中国专家共识[J]. 中华老年医学杂志, 2017,36(3):251-256.
[2]	Collard RM, Boter H, Schoevers RA , et al. Prevalence of frailty in community-dwelling older persons:a systematic review[J]. J Am Geriatr Soc, 2012,60(8):1487-1492.
[3]	侯晓琳, 高静, 吴晨曦 , 等. 养老机构老年人衰弱现状及分析[J]. 中华护理杂志, 2018,53(1):88-93.
[4]	Campitelli MA, Bronskill SE, Hogan DB , et al. The prevalence and health consequences of frailty in a population-based older home care cohort:a comparison of different measures[J]. BMC Geriatr, 2016,16:133.
[5]	王守琦, 石颖, 张美玲 , 等. 老年人衰弱干预的研究进展[J]. 中华护理杂志, 2017,52(3):365-368.
[6]	Bock JO, Konig HH, Brenner H , et al. Associations of frailty with healthcare costsd results of the ESTHER cohort study[J]. BMC Health Serv Res, 2016,16:128.
[7]	Payne CF, Wade A, Kabudula CW , et al. Prevalence and correlates of frailty in an older rural African population:findings from the HAALSI cohort study[J]. BMC Geriatr, 2017,17(1):293.
[8]	Brouwers M, Kho M, Browman G , et al. AGREE II:advancing guideline development,reporting and evaluation in health care[J]. CMAJ, 2010,182(18):E839-E842.
[9]	周芬, 郝玉芳, 丛雪等. 指南研究与评价工具AGREE Ⅱ及各领域分值的补充解释及思考[J]. 护理学报, 2018,25(18):56-58.
[10]	李春波, 何燕玲, 张明园 . 一致性检验方法的合理应用[J]. 上海精神医学, 2000,12(4):228-230,232.
[11]	Dent E, Lien C, Lim WS , et al. The Asia-Pacific Clinical Prac-tice Guidelines for the management of frailty[J]. J Am Med Dir Assoc, 2017,18(7):564-575.
[12]	Crandall M, Duncan T, Mallat A , et al. Prevention of fall-related injuries in the elderly:an eastern association for the surgery of Trauma Practice Management Guideline[J]. J Trauma Acute Care Surg, 2016,81(1):196-206.
[13]	National Guideline Clearinghouse. Frailty in elderly people[EB/OL].( 2013 -07-06)[2015-08-11]. .
[14]	Guyatt GH, Oxman AD, Vist GE , et al. GRADE:an emerging consensus on rating quality of evidence and strength of recommendations[J]. BMJ, 2008,336(7650):924-926.
[15]	Holroyd-Leduc J, Resin J, Ashley L , et al. Giving voice to older adults living with frailty and their family caregivers:engagement of older adults living with frailty in research,healthcare decision making,and in health policy[J]. Res Involv Engagem, 2016,2:23.
[16]	Guyatt GH, Oxman AD, Kunz R , et al. Going from evidences to recommendations[J]. BMJ, 2008,336(7652):1049-1051.
[17]	韦当, 王聪尧, 肖晓娟 , 等. 指南研究与评价(AGREEⅡ)工具实例解读[J]. 中国循证儿科杂志, 2013,8(4):316-319.
[18]	Graham ID, Logan J, Harrison MB , et al. Lost in knowledge translation:time for a map[J]. J Contin Educ Health Prof, 2006,26(1):13-24.
[19]	Jacqueline MT, Graham ID, Scott V . What does it mean to transform knowledge into action in falls prevention research? Perspectives from the Canadian institutes of health research[J]. J Safety Res, 2011,42(6):423-426.
[20]	Kitson A, Harvey G, Mccormack B . Enabling the implementation of evidence based practice:a conceptual framework[J]. Qual Health Care, 1998,7(3):149-158.
[21]	Stetler CB, Damschroder LJ, Helfrich CD , et al. A guide for applying arevised version of the PARIHS framework for implementation[J]. Implement Sci, 2011,6:99.
[22]	British Geriatrics Society. fit for frailty[EB/OL].( 2014. 08-30)[2019-01-13]. .
[23]	Turner G, Clegg A, AGE UK . Best practice guidelines for the management of frailty:a British Geriatrics Society,Age UK and Royal College of General Practitioners report[J]. Age Ageing, 2014,4(6):744-747.
[24]	Sarah Jo Brown . 循证护理—弥合科研与实践的鸿沟[M]. 郝玉芳, 晏利姣主译. 3版. 北京:北京大学医学出版社, 2017.