社区居家养老模式下老年人健康结局的Meta分析

Meta-Analysis of Health Outcomes in Older Adults under the Community-Based Home Care Model

摘要: 目的：对社区居家养老模式下60岁及以上老年人健康结局进行综合评估，以期为优化社区居家养老服务提供理论依据。方法：本研究检索了中国知网、PubMed、Embase等数据库，检索时限为各数据库建库至2025年3月24日，采用RevMan5.4软件进行Meta分析。结果：最终纳入5项研究，涉及31,247名参与者。社区居家养老对老年人认知功能(P < 0.001)改善更为显著，但对日常生活活动能力(P = 0.5)和工具性日常生活活动能力(P = 0.74)改善效果不一致，在抑郁结局方面，接受社区居家养老服务的老年人CES-D评分更高(P < 0.001)。鉴于纳入研究均为观察性研究，该结果仅提示相关性，不能据此推断服务导致抑郁加重。结论：社区居家养老模式在认知结局方面显示统计学意义的改善；在ADL/IADL结局方面结果不一致且存在异质性；抑郁(CES-D)结局方面服务组评分更高，但由于纳入研究均为观察性设计，可能受选择偏倚/指征混杂影响，现有证据仅提示相关性，尚不能作因果解释。建议未来探索适配不同功能状态老年人的服务策略，并完善心理健康支持与评估体系，以进一步提升社区居家养老服务质量与效果。

Abstract: Objective: To comprehensively evaluate health outcomes among adults aged ≥60 years receiving community-based home care services, and to provide evidence to inform optimization of such services. Methods: CNKI, PubMed, and Embase were searched from inception to March 24, 2025. Meta-analysis was performed using RevMan 5.4. Results: Five studies involving 31,247 participants were included. Community-based home care was associated with a statistically significant improvement in cognitive function (P < 0.001). However, findings were inconsistent for activities of daily living (ADL; P = 0.5) and instrumental activities of daily living (IADL; P = 0.74). For depressive outcomes, older adults receiving community-based home care had higher CES-D scores (P < 0.001). As all included studies were observational, this finding indicates an association only and should not be interpreted as evidence that the service causes worsening depression. Conclusion: Community-based home care showed a statistically significant improvement in cognitive outcomes, while results for ADL/IADL were inconsistent and heterogeneous. Although the service group had higher CES-D scores, this association may be influenced by selection bias and confounding by indication inherent to observational designs; therefore, causal inference cannot be made. Future studies should explore service strategies tailored to older adults with different functional statuses and strengthen mental health support and evaluation systems to further improve the quality and effectiveness of community-based home care.