Burdick Daniel J, Rosenblatt Adam, Samus Quincy M, Steele Cynthia, Baker Alva, Harper Michael, Mayer Lawrence, Brandt Jason, Rabins Peter, Lyketsos Constantine G
Division of Geriatric Psychiatry, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
J Gerontol A Biol Sci Med Sci. 2005 Feb;60(2):258-64. doi: 10.1093/gerona/60.2.258.
Assisted living is a popular residential option for older individuals, yet little research has been done on people choosing this option. This study examines predictors of functional impairment in assisted living residents in the domains of cognition, mood, and health.
An experienced team of neuropsychiatrists, nurses, and technicians using a number of cognitive, behavioral, health, and functional status tests and a cross-sectional study design assessed 198 residents of 22 assisted living facilities in Maryland. Data from these evaluations were used in univariate and multiple regression models to identify predictors of functional impairment, operationalized as the sum of the scores on two scales, one measuring impairment in basic activities of daily living and one measuring impairment in instrumental activities of daily living.
Greater cognitive impairment, worse depression, and worse medical health were significant independent predictors of functional impairment, together explaining a sizeable portion of the variance (adjusted R2=0.434). None of the demographic variables examined individually, including age and education, was predictive of functional impairment. In an analysis of specific cognitive domains, executive dysfunction, impairment of visuospatial skills, and amnesia were significant predictors of impairment, whereas inattention was not.
Executive dysfunction, apraxia, memory impairment, depression, and general medical health are all significant predictors of functional impairment in assisted living residents, with executive dysfunction being the strongest. These results may be instrumental in developing a more efficient model of care for residents of assisted living facilities, one based on having accurate predictive models of degree of impairment.
辅助生活是老年人中一种受欢迎的居住选择，但针对选择这种方式的人群的研究较少。本研究考察了辅助生活居民在认知、情绪和健康领域功能障碍的预测因素。
一个由神经精神科医生、护士和技术人员组成的经验丰富的团队，采用多项认知、行为、健康和功能状态测试以及横断面研究设计，对马里兰州22家辅助生活设施中的198名居民进行了评估。这些评估数据被用于单变量和多元回归模型，以确定功能障碍（定义为两个量表得分之和，一个测量日常生活基本活动中的障碍，另一个测量日常生活工具性活动中的障碍）的预测因素。
更严重的认知障碍、更严重的抑郁和更差的身体健康状况是功能障碍的显著独立预测因素，共同解释了相当一部分的方差（调整后R2 = 0.434）。单独考察的人口统计学变量，包括年龄和教育程度，均不能预测功能障碍。在对特定认知领域的分析中，执行功能障碍、视觉空间技能受损和失忆是功能障碍的显著预测因素，而注意力不集中则不是。
执行功能障碍、失用症、记忆障碍、抑郁和总体身体健康状况都是辅助生活居民功能障碍的显著预测因素，其中执行功能障碍最为显著。这些结果可能有助于为辅助生活设施居民开发一种更有效的护理模式，该模式基于对损伤程度有准确的预测模型。
