背景:世界人口正在迅速老龄化。康复是改善老年人健康和功能的最有效的健康战略之一。需要了解目前在初级保健(PC)中提供的康复服务,以优化老龄化人口的康复服务。这项范围界定审查的目的是a)描述目前如何在PC中向老年人提供康复服务,b)探讨所提供康复服务类型与年龄有关的差异。
方法:我们对研究老年人康复模型的范围审查进行了二次分析,专注于PC。搜索Medline和Embase(2015-2022),以确定以英语发表的有关50岁以上人群康复服务的研究。两位作者使用世界卫生组织(WHO)的操作框架独立筛选记录并提取数据,初级卫生保健系统(PRIMASYS)方法和世卫组织关于PC康复的论文。数据综合包括定量和定性分析。
结果:我们综合了96项研究的数据,88.6%在高收入国家(HIC)进行,与31,956名参与者一起,并确定了五种在PC中向老年人提供康复的模式:社区,home,远程康复,门诊和老年护理。护士,物理治疗师,职业治疗师是最常见的提供者,在15.6%的研究中报告了任务转移。最常见的干预措施是评估功能,康复协调,治疗性锻炼,心理干预,和自我管理教育。很少报道环境适应和辅助技术。
结论:我们描述了目前如何在PC中提供康复服务,并探讨了与年龄相关的康复服务类型的差异。PC可以在评估功能和协调康复过程中发挥关键作用,也可以很好地提供康复干预措施。通过了解PC中的康复服务交付模型,利益攸关方可以努力开发更全面和更容易获得的服务,以满足老龄化人口的不同需求。我们的发现,这突出了康复在健康老龄化中的作用,是通知政策的宝贵资源,联合国健康老龄化十年背景下的实践和未来研究,Rehab2030倡议和最近通过的WHA关于加强卫生系统康复的决议,但结论只能应用于HIC,需要更多的研究来反映低收入和中等收入国家的现实。
BACKGROUND: The world population is ageing rapidly. Rehabilitation is one of the most effective health strategies for improving the health and functioning of older persons. An understanding of the current provision of rehabilitation services in primary care (PC) is needed to optimise access to rehabilitation for an ageing population. The objectives of this scoping review are a) to describe how rehabilitation services are currently offered in PC to older persons, and b) to explore age-related differences in the type of rehabilitation services provided.
METHODS: We conducted a secondary analysis of a scoping review examining rehabilitation models for older persons, with a focus on PC. Medline and Embase (2015-2022) were searched to identify studies published in English on rehabilitation services for people aged 50 + . Two authors independently screened records and extracted data using the World Health Organization (WHO)\'s operational framework, the Primary Health Care Systems (PRIMASYS) approach and the WHO paper on rehabilitation in PC. Data synthesis included quantitative and qualitative analysis.
RESULTS: We synthesised data from 96 studies, 88.6% conducted in high-income countries (HICs), with 31,956 participants and identified five models for delivering rehabilitation to older persons in PC: community, home, telerehabilitation, outpatient and eldercare. Nurses, physiotherapists, and occupational therapists were the most common providers, with task-shifting reported in 15.6% of studies. The most common interventions were assessment of functioning, rehabilitation coordination, therapeutic exercise, psychological interventions, and self-management education. Environmental adaptations and assistive technology were rarely reported.
CONCLUSIONS: We described how rehabilitation services are currently provided in PC and explored age-related differences in the type of rehabilitation services received. PC can play a key role in assessing functioning and coordinating the rehabilitation process and is also well-placed to deliver rehabilitation interventions. By understanding models of rehabilitation service delivery in PC, stakeholders can work towards developing more comprehensive and accessible services that meet the diverse needs of an ageing population. Our findings, which highlight the role of rehabilitation in healthy ageing, are a valuable resource for informing policy, practice and future research in the context of the United Nations Decade of Healthy Ageing, the Rehab2030 initiative and the recently adopted WHA resolution on strengthening rehabilitation in health systems, but the conclusions can only be applied to HICs and more studies are needed that reflect the reality in low- and middle-income countries.