認知症および認知機能低下を有する入院高齢者への多職種退院支援の有効性―システマティックレビューとメタアナリシス

Effectiveness of Interdisciplinary Discharge Intervention for Hospitalized Older Adults with Neurocognitive Disorder and Cognitive Impairment:A Systematic Review and Meta-analysis

抄録

　目的：認知症・認知機能低下を伴う入院高齢者への多職種連携による退院支援が，在院日数短縮，QOL向上に有効か，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：PRISMAの手法を用いてシステマティックレビューとメタアナリシスを行った．適格基準は①認知機能障害のある平均年齢65歳以上の入院高齢者，②多職種による退院支援，③対照は通常ケア（対照群），④ランダム化比較試験とした．メタアナリシスはRev Man 5.4.1を用いて変量効果モデルによる分析，異質性はI²で評価した．結果：採択6文献のメタアナリシスより，介入群と対照群の在院日数，QOLのアウトカムに有意差は認めなかった．結論：認知症高齢者の在院日数短縮，QOLの向上に対し，退院支援の有効性は示されなかった．今後，多職種退院支援に関する研究を積み重ねる必要性が示唆された．

　Objective: This study aims to evaluate the effectiveness of interdisciplinary discharge intervention including discharge planning for inpatient older adults with neurocognitive disorders and cognitive impairment to improve outcomes such as length of hospital stay and quality of life.

　Methods: A systematic review and meta-analysis were performed using the PRISMA method. The eligible criteria were as follows: (1) study participants were older adults aged ≥65 having neurocognitive disorders, (2) an intervention group that received interdisciplinary discharge planning and (3) a control group that received “usual care”; and (4) the study was a randomized controlled trial. For the meta-analysis, Review Manager 5.4.1 was used for applying a random effects model. Heterogeneity was assessed using the I² statistic.

　Results: The meta-analysis showed no significant differences in outcomes between the intervention and control groups.

　Conclusions: The effectiveness of interdisciplinary discharge intervention to length of stay and quality of life for the older adults with neurocognitive disorders during hospitalization was not shown, suggesting the need for research on interdisciplinary discharge intervention.