Gill Thomas M, Guo Zhenchao, Allore Heather G
Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut 06504, USA.
J Am Geriatr Soc. 2006 Oct;54(10):1524-30. doi: 10.1111/j.1532-5415.2006.00890.x.
To quantify the burden of bathing disability over time; to determine whether the burden of bathing disability differs according to age, sex, and physical frailty; and to evaluate the relationship between disability in bathing and disability in other essential activities of daily living (ADLs).
Prospective cohort study.
General community in greater New Haven, Connecticut.
Seven hundred fifty-four community-living older persons aged 70 and older who were nondisabled (required no personal assistance) in four essential ADLs: bathing, dressing, transferring from a chair, and walking inside the house.
Bathing disability, defined as the inability to wash and dry one's whole body without personal assistance, was assessed every month for up to 6 years, along with disability in dressing, transferring, and walking.
Over the course of 6 years, 440 participants (58.4%) had at least one episode of bathing disability, and 266 (34.0%) had multiple episodes, with the duration of each episode averaging about 6 months. Whether assessed as number of episodes, duration of episodes, incidence rates, or number of months per 100 months, the burden of bathing disability was greatest in participants who were physically frail and was consistently higher in women than men and in participants who were aged 80 and older than those who were aged 70 to 79. Most episodes of bathing disability (86.1%) were not preceded in the prior month by disability in dressing, transferring, or walking, and nearly half (48.3%) were not accompanied at onset by disability in one or more of these other ADLs. In a multivariable model that included age, sex, and physical frailty, the onset of bathing disability increased the likelihood of developing disability in the other essential ADLs the following month fivefold (hazard ratio=5.1, 95% confidence interval=4.1-6.4).
Disability in bathing may serve as a sentinel event in the disabling process. Given the recurrent nature of bathing disability, programs designed to enhance independent bathing will need to focus not only on the prevention of bathing disability, but also on the restoration and maintenance of independent bathing in older persons who become disabled.
量化随时间推移洗澡障碍的负担；确定洗澡障碍的负担是否因年龄、性别和身体虚弱程度而异；并评估洗澡障碍与其他基本日常生活活动（ADL）障碍之间的关系。
前瞻性队列研究。
康涅狄格州大纽黑文的普通社区。
754名70岁及以上的社区居住老年人，他们在四项基本ADL（洗澡、穿衣、从椅子上起身和在屋内行走）中无残疾（无需个人协助）。
洗澡障碍定义为在无人协助下无法自行清洗和擦干全身，长达6年的时间里每月对其进行评估，同时评估穿衣、起身和行走方面的障碍。
在6年期间，440名参与者（58.4%）至少有一次洗澡障碍发作，266名（34.0%）有多次发作，每次发作持续时间平均约6个月。无论以发作次数、发作持续时间、发病率还是每100个月的月数来评估，洗澡障碍负担在身体虚弱的参与者中最大，并且在女性中始终高于男性，在80岁及以上的参与者中高于70至79岁的参与者。大多数洗澡障碍发作（86.1%）在前一个月没有穿衣、起身或行走障碍，近一半（48.3%）在发作时没有一项或多项其他ADL障碍伴随。在一个包括年龄、性别和身体虚弱程度的多变量模型中，洗澡障碍的发作使下个月在其他基本ADL中出现障碍的可能性增加了五倍（风险比=5.1，95%置信区间=4.1 - 6.4）。
洗澡障碍可能是致残过程中的一个警示事件。鉴于洗澡障碍的反复性，旨在增强独立洗澡能力的项目不仅需要关注洗澡障碍的预防，还需要关注恢复和维持已残疾老年人的独立洗澡能力。
