Abstract:

Objective To evaluate the quality and synthesize the recommendations of guidelines on the assessment and management of eating problems among dementia patients. Methods Guidelines involving recommendations of assessment and management of eating problems among dementia patients were searched in guideline networks,websites of Alzheimer's Disease associations and databases from inception to December 19,2018. AGREE-II and related quality assessment tools were used to evaluate the quality of the guidelines. The recommendations related to the assessment and management of eating problems of dementia were synthesized. Results A total of 450 articles were initially detected,and finally 6 guidelines as well as 1 expert consensus,4 best practices,and 2 recommended practices were included. The average scores of the AGREE Ⅱ were 87.50% for the scope and purpose,61.58% for the stakeholder involvement,45.14% for the rigor of development,78.70% for the clarity of presentation,35.07% for the application,and 33.33% for the editorial independence,which were rated as Grade B. The included expert consensus,best practices,and recommended practices were from China,the United States,and Australia,respectively. Recommendations related to eating problem assessment and management involved in nutrition and eating problem assessment,adjusting the eating environment,maintaining eating autonomy,adjusting food types and delivery methods,caregiver support,dysphagia coping measures,nutritional supplements,and enteral nutrition. Conclusion The guidelines are of moderate quality,and the applicability,independence and rigor of the guidelines need to be improved. The recommendations are scattered in different guidelines and lack targeted responses to specific eating problems,and some recommendations are still controversial.

Key words: Dementia, Eating Problems, Guidebooks, Quality Appraisal

摘要：

目的 对痴呆患者进食问题评估与管理相关指南进行质量评价和内容分析,为制订痴呆患者进食问题评估与管理规范提供依据。 方法 计算机检索国内外指南网、相关学会网站及数据库,搜集痴呆患者进食问题评估与管理相关指南,检索时限为建库至2018年12月19日。应用标准的质量评价工具对指南进行质量评价,汇总痴呆患者进食问题评估与管理的推荐意见。 结果 初检到450篇文献,最终纳入6篇指南、1篇专家共识、4篇最佳实践和2篇推荐实践。6篇指南均来自国外,使用临床指南研究与评估系统Ⅱ对其进行质量评价并计算各领域的平均得分,分别为范围和目的87.50%、参与人员61.58%、严谨性45.14%、清晰性78.70%、应用性35.07% 和独立性33.33%,总体质量均为B级;纳入的专家共识、最佳实践、推荐实践分别来自中国、美国和澳大利亚。进食问题评估与管理有关推荐意见涉及营养和进食问题评估、调整进餐环境、维持进食自主性、调整食物类型和提供方式、照护者支持、吞咽困难应对、营养补充剂、肠内营养8个方面。 结论 纳入的指南质量中等,在应用性、独立性和严谨性领域有待提高。关于进食评估与管理的推荐意见散在分布,缺乏针对具体进食问题的应对措施,部分推荐意见尚有争议。

关键词: 痴呆, 进食问题, 指南, 质量评价