认知障碍患者住院期间走失风险管理的最佳证据总结

doi:10.3761/j.issn.1672-9234.2022.11.016

摘要/Abstract

摘要：

目的总结评价认知障碍患者走失风险管理的最佳证据，为临床护理工作提供循证依据。方法计算机检索BMJ Best Practice、UpToDate、英国国家临床示范研究所、国际指南协作网、苏格兰校际间指南网、加拿大安大略护理学会、美国国家指南交换中心、加拿大医学会临床实践指南信息库、新西兰临床实践指南、澳大利亚临床实践指南平台、德国医学科学协会、Cochrane Library、Embase、PubMed、中国知网、万方数据库、医脉通数据库中与认知障碍患者走失风险管理相关的内容。检索时间均为建库至2021年10月15日。由2名研究者按照JBI循证卫生保健中心的文献评价标准和证据分级系统对文献进行独立评价，并对证据进行提取、汇总和分析。结果共纳入12篇文献，结合专业人员的判断，汇总了49条预防与管理认知障碍患者走失相关的证据，包括风险评估、环境改造、行为干预、培训教育、生理及心理干预、智能设备、搜寻策略7个方面。结论该研究汇总了认知障碍患者在住院期间走失风险管理的最佳证据，为临床护理工作提供循证依据。

关键词: 认知障碍, 游走行为, 循证护理学, 安全管理

Abstract:

Objective To retrieve the evidence of wandering for patients with cognitive impairment，and to summarize the best evidence. Methods A comprehensive search was conducted in BMJ Best Practice，UpToDate，National Institute for Health and Care Research，Guideline International Network，Scottish Intercollegiate Guidelines Network，Registered Nurses Association of Ontario，National Guideline Clearinghouse，Canadian Medical Association CPG Infobase，New Zealand Guidelines Group，Australian Clinical Practice Guidelines，Association of the Scientific Medical Societies in Germany，Cochrane Library，Embase，PubMed，CNKI，Wanfang Database，Yimaitong from inception to October 15，2021. Two researchers independently evaluated the articles in accordance with the literature evaluation standards and evidence grading system of the Joanna Briggs Institute of Evidence-based Health Care in Australia，and extracted the evidence. Results A total of 12 articles were included and 49 pieces of evidence related to the management of cognitive impairment patients were compiled，including the seven aspects：risk assessment，environmental modification，behavior intervention，training and education，physical and psychological intervention，smart devices，and search strategy. Conclusion The study summarizes the best evidence related to the management of cognitive impairment patients，which can provide evidence for the development of clinical care.

Key words: Cognitive Disorders, Wandering Behavior, Evidence-Based Nursing, Safety Management

唐起岚,徐艳华,陈成群,黄蕾,丁春戈,张亚斌. 认知障碍患者住院期间走失风险管理的最佳证据总结[J]. 中华护理教育, 2022, 19(11): 1038-1045.

TANG Qilan,XU Yanhua,CHEN Chengqun,HUANG Lei,DING Chunge,ZHANG Yabin. Evidence summary of management of wandering in people with cognitive impairment[J]. Chinese Journal of Nursing Education, 2022, 19(11): 1038-1045.

图/表 5

参考文献 38

[1]	Bowen ME, Rowe M. Wandering behaviors and activities of daily living among older adults with cognitive impairment[J]. Rehabil Nurs, 2019, 44(5):282-289. doi: 10.1097/rnj.0000000000000148 pmid: 29613878
[2]	Petersen RC, Lopez O, Armstrong MJ, et al. Practice guideline update summary:mild cognitive impairment:report of the Gui-deline Development,Dissemination,and Implementation Subcommittee of the American Academy of Neurology[J]. Neurology, 2018, 90(3):126-135. doi: 10.1212/WNL.0000000000004826
[3]	Deng Y, Zhao SQ, Cheng GW, et al. The prevalence of mild cognitive impairment among Chinese people:a meta-analysis[J]. Neuroepidemiology, 2021, 55(2):79-91. doi: 10.1159/000512597
[4]	Neubauer NA, Liu L. Evaluation of antecedent behaviors of dementia-related wandering in community and facility settings[J]. Neurodegener Dis Manag, 2020, 10(3):125-135. doi: 10.2217/nmt-2019-0030 pmid: 32552463
[5]	GBD Dementia Collaborators. and national burden of Alzheimer’s disease and other dementias,1990-2016:a systematic analysis for the Global Burden of Disease Study 2016[J]. Lancet Neurol, 2019, 18(1):88-106. doi: 10.1016/S1474-4422(18)30403-4
[6]	Ferri CP, Prince M, Brayne C, et al. Global prevalence of dementia:a Delphi consensus study[J]. Lancet, 2005, 366(9503):2112-2117. doi: 10.1016/S0140-6736(05)67889-0
[7]	Barnard-Brak L, Richman DM, Owen DC. Assessing wandering risk among individuals with Alzheimer’s disease and dementia:a pilot study[J]. Psychogeriatrics, 2018, 18(5):388-392. doi: 10.1111/psyg.12336 pmid: 29987882
[8]	Peng LM, Chiu YC, Liang J, et al. Risky wandering behaviors of persons with dementia predict family caregivers’ health outcomes[J]. Aging Ment Health, 2018, 22(12):1650-1657. doi: 10.1080/13607863.2017.1387764 pmid: 29169254
[9]	周芬, 郝玉芳, 丛雪, 等. 指南研究与评价工具AGREE Ⅱ及各领域分值的补充解释及思考[J]. 护理学报, 2018, 25(18):56-58.
	Zhou F, Hao YF, Cong X, et al. Supplementary explanation and reflection on the research and evaluation tool AGREE Ⅱ and the scores of each field[J]. J Nurs(China), 2018, 25(18):56-58.
[10]	胡雁. 循证护理学[M]. 北京: 人民卫生出版社, 2012.
	Hu Y. Evidence-based nursing[M]. Beijing: People’s Medical Publishing House, 2012.
[11]	Press D, Alexander M. Safety and societal issues related to dementia[EB/OL].(2018-03)[2021-11-02]. http://www-uptodate-com-443.webvpn.bjmu.tsg211.com/contents/zh-Hans/safety-and-societal-issues-related-to-dementia.
[12]	Canadian Task Force on Preventive Health Care. Recommendations on screening for cognitive impairment in older adults[EB/OL].(2016-01-05)[2021-11-02]. https://www.cmaj.ca/content/188/1/37.
[13]	National Institute for Health and Care Excellence(UK). Dementia:assessment,management and support for people living with dementia and their carers[EB/OL].(2018-06-20)[2021-11-02]. https://www.nice.org.uk/guidance/ng97.
[14]	Ismail Z, Black SE, Camicioli R, et al. CCCDTD5 participants. Recommendations of the 5th Canadian Consensus Conference on the diagnosis and treatment of dementia[EB/OL].(2020-07-29)[2021-11-02]. http://guide.medlive.cn/guideline/15194.
[15]	Australian National Health and Medical Research Council (NHMRC). Clinical practice guidelines and principles of care for people with dementia[EB/OL].(2016-02)[2021-11-02]. http://cdpc.sydney.edu.au/wp-content/uploads/2019/06/CDPC-De-mentia-Guidelines_WEB.pdf.
[16]	Shaji KS, Sivakumar PT, Rao GP, et al. Clinical practice gui-delines for management of dementia[J]. Indian J Psychiatry, 2018, 60(Suppl 3):S312-S328.
[17]	Futrell M, Melillo KD, Remington R, et al. Evidence-based prac-tice guideline:wandering[J]. J Gerontol Nurs, 2014, 40(11):16-23. doi: 10.3928/00989134-20140911-01 pmid: 25310096
[18]	Siders C, Nelson A, Brown LM, et al. Evidence for implementing nonpharmacological interventions for wandering[J]. Rehabil Nurs, 2004, 29(6):195-206. pmid: 15597998
[19]	Leng MM, Zhao YJ, Xiao HM, et al. Internet-based supportive interventions for family caregivers of people with dementia:systematic review and meta-analysis[J]. J Med Internet Res, 2020, 22(9):e19468. doi: 10.2196/19468
[20]	Etxeberria I, Salaberria K, Gorostiaga A. Online support for family caregivers of people with dementia:a systematic review and meta-analysis of RCTs and quasi-experimental studies[J]. Aging Ment Health, 2021, 25(7):1165-1180. doi: 10.1080/13607863.2020.1758900
[21]	Gu L. Nursing interventions in managing wandering behavior in patients with dementia:a literature review[J]. Arch Psychiatr Nurs, 2015, 29(6):454-457. doi: 10.1016/j.apnu.2015.06.003
[22]	MacAndrew M, Brooks D, Beattie E. NonPharmacological interventions for managing wandering in the community:a narrative review of the evidence base[J]. Health Soc Care Commu-nity, 2019, 27(2):306-319.
[23]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 Edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[24]	Kang JM, Cho YS, Park S, et al. Montreal cognitive assessment reflects cognitive reserve[J]. BMC Geriatr, 2018, 18(1):261. doi: 10.1186/s12877-018-0951-8 pmid: 30376815
[25]	Liew TM. A 4-item case-finding tool to detect dementia in older persons[J]. J Am Med Dir Assoc, 2019, 20(12):1529-1534.e6. doi: S1525-8610(19)30510-9 pmid: 31399363
[26]	Shi D, Chen X, Li Z. Diagnostic test accuracy of the Montreal Cognitive Assessment in the detection of post-stroke cognitive impairment under different stages and cutoffs:a systematic review and meta-analysis[J]. Neurol Sci, 2018, 39(4):705-716. doi: 10.1007/s10072-018-3254-0
[27]	Yao L. Locomoting responses to environment in elders with dementia(LRE-EWD):a model construction and preliminary testing[D] Ann Arbor,Michigan: University of Michigan, 2004.
[28]	Yao L, Algase D. Environmental ambiance as a new window on wandering[J]. West J Nurs Res, 2006, 28(1):89-104. pmid: 16676727
[29]	顾爱芳, 诸凤芳, 董萍, 等. 住院老年痴呆患者徘徊行为发生情况及危险因素分析[J]. 中华现代护理杂志, 2017, 23(14):1900-1903.
	Gu AF, Zhu FF, Dong P, et al. Incidence and risk factors of wander behavior among inpatients with senile dementia[J]. Chin J Mod Nurs, 2017, 23(14):1900-1903.
[30]	黄兆晶, 张雪梅. 老年痴呆患者走失防范干预的效果观察[J]. 护理学报, 2016, 23(18):62-64.
	Huang ZJ, Zhang XM. Observation on the effect of prevention and intervention of lost in senile dementia patients[J]. J Nurs (China), 2016, 23(18):62-64.
[31]	Lauritzen J, Pedersen PU, Sørensen EE, et al. The meaningfulness of participating in support groups for informal caregivers of older adults with dementia:a systematic review[J]. JBI Da-tabase System Rev Implement Rep, 2015, 13(6):373-433.
[32]	Pot AM, Gallagher-Thompson D, Xiao LD, et al. iSupport:a WHO global online intervention for informal caregivers of people with dementia[J]. World Psychiatry, 2019, 18(3):365-366. doi: 10.1002/wps.20684
[33]	Baruah U, Varghese M, Loganathan S, et al. Feasibility and preliminary effectiveness of an online training and support program for caregivers of people with dementia in India:a randomized controlled trial[J]. Int J Geriatr Psychiatry, 2021, 36(4):606-617. doi: 10.1002/gps.5502
[34]	Baruah U, Loganathan S, Shivakumar P, et al. Adaptation of an online training and support program for caregivers of people with dementia to Indian cultural setting[J]. Asian J Psychiatr, 2021, 59:102624. doi: 10.1016/j.ajp.2021.102624
[35]	Holliday-Welsh DM, Gessert CE, Renier CM. Massage in the management of agitation in nursing home residents with cognitive impairment[J]. Geriatr Nurs, 2009, 30(2):108-117. doi: 10.1016/j.gerinurse.2008.06.016 pmid: 19345850
[36]	Xiao SD, Wang Y, Duan SM, et al. Effects of aromatherapy on agitation and aggression in cognitive impairment:a meta-analysis[J]. J Clin Nurs, 2021, 38(3):2021Aug5.doi:10.1111/jocn.15984. Epub ahead of print. PMID: 34355444. doi: 10.1111/jocn.15984
[37]	Jeon SY, Yi D, Byun MS, et al. Differential patterns of regional cerebral hypometabolism according to the level of cerebral amyloid deposition in patients with amnestic mild cognitive impairment[J]. Neurosci Lett, 2016, 632:104-108. doi: 10.1016/j.neulet.2016.08.045 pmid: 27574728
[38]	Nishigaki Y, Tanaka K, Kim J, et al. Development of an image processing support system based on fluorescent dye to prevent elderly people with dementia from wandering[J]. Annu Int Conf IEEE Eng Med Biol Soc, 2013, 2013:7302-7305. doi: 10.1109/EMBC.2013.6611244 pmid: 24111431