認知症および認知機能低下者を含む高齢入院患者群への老年専門職チームによる介入の在院日数短縮等への有効性；システマティックレビューとメタアナリシス

Systematic Review and Meta-analysis of Geriatric Specialist Health Care Team Implementations to Reduce Hospital Bed Days for Older Adult Inpatients with Dementia and Cognitive Disorders

抄録

【目的】　老年専門職チームによる入院中の介入が，通常ケアと比較して，認知症，および認知機能の低下者を含む入院高齢患者群への在院日数の減少等の臨床指標が良好であるかをシステマティックレビューとメタアナリシスにより評価する．

【方法】　和英文献データベースを用いて2014年7月に検索を行い，①ランダム化比較試験，②65歳以上の入院患者への医療，③MMSE等により対象者の認知機能をスクリーニングしているか，または認知症と診断されている，④老年科医や老年専門看護師等の複数職種で構成する老年専門職チームによるアセスメントと介入を行っているという適格基準を満たした文献を評価した．解析には変量効果モデルを用い，リスク比と平均差を算出し，異質性はI²統計量により評価した．

【結果】　メタアナリシスには7文献，301〜999人分を統合した．老年専門職チームによる介入は，認知症，認知機能の低下者を含む入院高齢患者群への平均在院日数を有意に減少した．しかし，入院中死亡率，退院時・退院後1年間のナーシングホーム入所の減少効果は明確ではなかった．

【結論】　老年専門職チームによる介入は認知症，認知機能の低下者を含む入院高齢患者群への平均在院日数の減少に有効であるが，エビデンスは限定的である．

[Purpose] This systematic review and meta-analysis evaluated the effects of Gerontological specialist healthcare team implementations to reduce hospital bed days, and other clinical outcomes for older adult inpatients with dementia and cognitive disorders, and compared them with the effects of conventional standard healthcare.

[Method] An extensive literature search of several databases was performed in July, 2014 that included both Japanese and English articles. The articles were categorized as: i) randomized controlled trials, ii) intervention performed in the hospital for older adults aged ≥ 65, iii) screened subject's cognitive status using MMSE or other scales, or diagnosed dementia, iv) geriatric specialist healthcare team including assessment and implementations with more than two specialists such as gerontologists and gerontological nurse specialists, and were then evaluated. A random effects model was applied. Risk ratio and mean difference were calculated. Heterogeneity was assessed using the I² statistic.

[Results] Seven original articles involving 301〜999 participants were identified in the meta-analysis. Geriatric specialist healthcare team implementations for inpatients with dementia and cognitive disorder reduced the mean hospital bed days. However, it did not affect the mortality during admission, use of institutional services at discharge and during one year after discharge, and other clinical outcomes.

[Conclusion] It was possible to conclude that Geriatric specialist healthcare team implementations for inpatients with dementia and cognitive disorder significantly reduce the mean hospital bed days; however, the evidence was shown to be limited.