社区衰弱和肌少症老年人膳食营养干预的障碍和促进因素:质性 研究的meta整合

Facilitators and barriers to the implementation of dietary nutrition interventions for community-dwelling older adults with physical frailty and sarcopenia: A qualitative meta-synthesis

目的随着老龄化社会进程加速,老年人躯体衰弱和肌少症的患病率逐年上升,并带来诸多不良影响。膳食营养是防治躯体衰弱和肌少症的重要方式,但在社区环境中实施膳食营养干预受到诸多复杂因素影响。本综述旨在对相关研究中的促进和障碍因素进行系统综述,为制订相关健康管理方案提供参考。方法在Pub Med. .Web of Science 、Medline(Ovid). Embase(Ovid)和Cochrane Library 数据库进行检索,发表时间限定为建库至2023年1月。使用主题词和自由词组合完成检索。使用英国牛津大学循证医学中心质性研究质量评价工具(the Critical Appraisal Skills Program Qualiative Sudies Checklist)对 纳入研究进行质量评价。利用社会生态建模框架对提取的信息进行编码和分析。本综述方案已在PROSPERO注册(CRD42022381339)。结果共纳入10项研究。其中,4项研究仅进行营养相关干预,而膳食营养和运动干预相结合的有6项。根据社会生态模型,从个体特征、外部环境和干预措施3个层面对促进和障碍因素进行了总结,包含10个副主题。结论对社区中的躯体衰弱和肌少症老年人实施膳食营养干预措施时,应整合个人内部动机和外部支持,为参与者制订“量身定制”的干预方案,并最大程度地优化可利用的人力和物理资源。

Objectives:With the acceleration of an aging society,the prevalence of age-related chronic diseases such as physical frailty and sarcopenia is gradually increasing with numerous adverse effects.Dietary nutrition is an important modifiable risk factor for the management of physical frailty and sarcopenia,but there are many complex influences on its implementation in community settings.This study aimed to summarize the facilitators and barriers to the implementation of dietary nutrition interventions for community-dwelling older adults with physical frailty and sarcopenia,and to provide a reference for the formulation of relevant health management programs.Methods:Searches were conducted in databases including PubMed,Web of Science,Medline(Ovid),Embase(Ovid),and Cochrane Library from inception to January 2023.Searches were completed for a combination of MeSH terms and free terms.The Critical Appraisal Skills Program(CASP)instrument was used to appraise quality.Coding and analysis of the extracted information were performed using the socio-ecological modeling framework.The study protocol for this review was registered on the PROSPERO(CRD42022381339).Results:A total of 10 studies were included.Of these,four were nutrition-only focused interventions,and six were dietary nutrition and exercise interventions.The facilitators and barriers were summarized based on the socio-ecological model that emerged at three levels:individual trait level,external environment level,and intervention-related level,containing ten subthemes.Conclusion:Individual internal motivation and external support should be integrated with the implementation of diet-and nutrition-related interventions in community-living aged people with physical frailty and sarcopenia.Develop“tailored”interventions for participants and maximize available human and physical resources.