长期照护机构老年人综合评估工具研究进展及系统评价

A Systematic Review of Recent Developments in Comprehensive Geriatric Assessment Instruments in Long-term Care Facilities

背景目前国内外的老年人综合评估工具较多,但我国养老机构的照护服务质量参差不齐,尚缺乏统一的老年人能力评估工具。目的系统评价国内外老年人综合评估工具的信效度并结合我国国情进行分析,以选择适合我国长期照护机构老年人综合评估的工具。方法于2018年1—6月,计算机检索中国知网、万方数据知识服务平台以及Scopus、PubMed、Usearch、CINAHL、PsycINFO、Medline数据库中与老年人综合评估有关的文献(发表时间为2008—2018年),以获取老年人综合评估工具及相关资料。采用"基于共识选择健康测量工具的标准"(COSMIN)评估合格文献中老年人综合评估工具的方法学质量。结果最终纳入合格文献21篇,涉及老年人综合评估工具9种,仅5种工具被汇报了信效度相关信息。根据COSMIN:国际居民长期照护评估工具(interRAI-LTCF)的内部一致性等级评定为一般,3篇文献中汇报的重测信度等级分别评定为差、一般、一般;诺丁汉健康量表(NHP)的内部一致性、重测信度等级评定为差;重庆市医院-养老机构-社区通用老年人健康综合评估量表(BGA)的效度和信度等级均被评定为差;老年人能力评估问卷的内部一致性等级评定为一般;老年人健康功能综合评价量表的内部一致性、内部效度、结构效度等级评定为差。结论 interRAI-LTCF和老年人能力评估问卷是未来值得在我国长期照护机构中进行推广的老年人综合评估工具,但仍需更多高质量的将评估工具应用于长期照护机构的研究来测量其信效度和可行性。

Background There are many comprehensive geriatric assessment(CGA)tools at home and abroad,but there are no unified CGA tools for older people in long-term care facilities(LTCF)delivering different qualities of care in China.Objective To review systematically the psychometric properties of CGA tools in LTCF and choose the appropriate ones for LTCF in China.Methods From January to June 2018,we performed an analysis of the data for CGA in LTCF published from 2008 to 2018 that were retrieved from eight databases:CNKI,Wanfang,Scopus,PubMed,Usearch,CINAHL,PsycINFO and Medline.The COSMIN checklist was used to assess the methodological quality of the eligible studies.Results Altogether,21 papers were included.Of the papers,there were 9 kinds of CGA instruments,but only 5 instruments'psychometric properties were reported.By use of the COSMIN checklist,the internal consistency of interRAI-LTCF was rated as fair,and its retest reliability was rated as poor,fair,and fair in 3 studies,respectively.The internal consistency and retest reliability of Nottingham Health Profile was evaluated as poor.Both the validity and reliability of BGA used in Chongqing's hospitals,elderly care facilities and community-based healthcare institutions were assessed as poor.The internal consistency of Ability Assessment for Older Adults was assessed as fair.The internal consistency,content validity and construct validity of Elderly Comprehensive Health Assessment Scale were assessed as poor.Conclusion Both the interRAI-LTCF and the Ability Assessment for Older Adults are worth promoting in LTCF in China,but their psychometric properties and feasibilities need to be tested by more high-quality studies.