养老机构老人认知障碍影响因素的Meta分析

An Etiological Study of Cognitive Impairment in the Institutional Elderly:A Meta-analysis

目的全面了解空巢老人认知功能障碍危险因素。方法检索Ovid Medline、Ovid Embase、Cochrane图书馆及中国生物医学文献数据库(光盘版)等数据库,检索时间为各数据库建库至2011年12月31日。文献纳入标准:年龄≥60岁或作者指明以老人为研究对象;居住状态包括老人无子女或未与子女同住。两位研究者独立地对符合纳入标准的试验进行质量评价和资料提取。结果 4篇文献(共1 485例)分析了养老机构老人认知障碍的影响因素,合并分析显示年龄[WMD=2.10岁,95%C(I1.28,2.92)岁,P<0.000 01]、女性[OR=3.61,95%C(I1.63,8.01),P=0.002]、失能[SMD=0.78,95%CI(0.36,1.20),P=0.000 2]、躯体健康[SMD=0.06,95%CI(0.01,0.11),P=0.02]、未婚/寡居[OR=3.16,95%CI(1.43,6.96),P<0.000 01]、文盲[OR=2.94,95%CI(1.06,8.14),P=0.04]、社会支持差[OR=7.29,95%CI(2.27,23.39),P=0.000 8]、朋友关系差[OR=2.14,95%CI(1.35,3.39),P=0.001]、参加活动少[OR=2.11,95%CI(1.36,3.29),P=0.000 9]及远离子女[OR=5.73,95%CI(3.33,9.87),P<0.05]是其危险因素。结论养老机构老人认知功能障碍的危险因素包括老年、女性、文盲、未婚/寡居、社交差、与子女距离远、躯体健康水平差及抑郁等。结果仅来源于较少的研究和数量较小的对象,且均为横断面研究,需谨慎看待上述结论。

Objective To have a comprehensive understanding of the cognitive impairment risk factors of the empty nest elderly. Methods Central, Medline, Embase, and CBM-disk were searched for potentially relevant articles published from the beginning to October 6, 2011 or December 12, 201l （the last database）. The inclusion criteria were： （~） age of subjects 〉 60 years old, （~） subjects not living with their children or grandchildren, and （~） original research reported in English or Chinese publication. Two reviewers independently assessed the trial quality. Results Four studies with 1 485 patients were used for analyzing the prediction of cognitive impairment of patients not living with children. The following were risk factors of cognitive impairment of institutional elderly： age [WMD=2.10, 95%CI （1.28, 2.92）, P 〈 0.000 01], female [OR=3.61, 95%CI （1.63, 8.01）, P=0.002], functional disability [SMD=0.78, 95%CI （0.36, 1.20）, P=0.000 2], physical disease [SMD=O.06, 95%CI （0.01, 0.11）, P=0.02], never being married or widowed [OR=3.16, 95%CI （1.43, 6.96）, P 〈 0.000 01], illiterate [OR=2.94, 95%CI （1.06, 8.14）, P=0.04], poor social support [OR=7.29, 95%CI （2.27, 23.39）, P=0.000 8], poor friendship [OR=2.14, 95%CI （1.35, 3.39）, P=0.001], diminished participation in activities [OR=2.11, 95%CI （1.36, 3.29）, P=-0.000 9] and living far from family [OR=5.73, 95%CI （3.33, 9.87）, P 〈 0.05]. Conclusions Risk factors of cognitive impairment of institutional elderly were old-age, female, illiteracy, never being married or widowed, poor social interaction, being far from family, poor physical health and depression. It needs to be cautious of the above conclusion that the results come from smaller studies and smaller sample, and all are cross-section studies.