Wang Jye, Kane Robert L, Eberly Lynn E, Virnig Beth A, Chang Ling-Hui
Department of Health Care Administration, Chang Jung Christian University, Taiwan, Republic of China.
J Gerontol A Biol Sci Med Sci. 2009 Apr;64(4):473-80. doi: 10.1093/gerona/gln040. Epub 2009 Feb 6.
Existing studies on the relationships between impairments and activities of daily living (ADLs) in nursing home residents have serious limitations. This study examines the relationships among admission impairments, including pain, depression, incontinence, balance, and falls, and follow-up ADLs, as well as the effect of the nursing home on follow-up ADLs of extended-stay nursing home residents.
This longitudinal cohort study consisted of 4,942 extended-stay residents who were admitted into 377 Minnesota nursing homes during 2004. General linear mixed models were used for all analyses, with 14 resident-level and 8 facility-level control variables.
Incontinence and balance function at admission were significantly associated with increases in ADL dependence at follow-up. Individual nursing homes had independent effects on all three ADL models. Similar findings were found after facility-level control variables were added.
Incontinence predicts subsequent ADL functional levels. The relationship between balance dysfunction and subsequent ADL dependence could be causal. Future studies of the causal relationships between impairments and ADL should examine the effectiveness of impairment interventions on ADL as well as these relationships in different subgroups of nursing home residents.
现有关于疗养院居民功能障碍与日常生活活动（ADL）之间关系的研究存在严重局限性。本研究考察入院时的功能障碍（包括疼痛、抑郁、失禁、平衡和跌倒）与随访时的ADL之间的关系，以及疗养院对长期居住的疗养院居民随访时ADL的影响。
这项纵向队列研究纳入了2004年期间入住明尼苏达州377家疗养院的4942名长期居住居民。所有分析均使用一般线性混合模型，并纳入14个居民层面和8个机构层面的控制变量。
入院时的失禁和平衡功能与随访时ADL依赖程度的增加显著相关。各个疗养院对所有三个ADL模型均有独立影响。在纳入机构层面的控制变量后也发现了类似结果。
失禁可预测随后的ADL功能水平。平衡功能障碍与随后的ADL依赖之间的关系可能存在因果联系。未来关于功能障碍与ADL之间因果关系的研究应考察功能障碍干预措施对ADL的有效性，以及这些关系在不同亚组疗养院居民中的情况。
