Faculty of Nursing, University of Alberta, Edmonton, Canada.
Int Psychogeriatr. 2011 Feb;23(1):54-64. doi: 10.1017/S1041610210000116. Epub 2010 Mar 4.
Inability to walk compromises the well-being of the growing number of nursing home residents with dementia. The purpose of this study was to estimate the incidence and identify predictors of walking disability that may be remediable.
A cohort was followed fortnightly for a year in 15 nursing homes in western Canada. The study participants comprised 120 ambulatory residents with middle-stage Alzheimer's, vascular or mixed dementia. Standardized measures of potential predictors of disability included the Charlson Comorbidity Index, Global Deterioration Scale, and Professional Environment Assessment Protocol. Walking disability was defined as using a wheelchair to go to meals in the dining room.
Incidence of walking disability was 40.8% (95% confidence interval (CI): 32.7-50.2). Approximately half of this (27.0%; 95% CI: 19.7-36.5) was excess disability. Residents with more advanced dementia and living in a less supportive nursing home environment experienced an increased hazard of walking disability (Hazard Ratio (HR): 2.1; 95% CI: 1.2-3.8 and HR: 2.4; 95% CI: 1.3-4.4 respectively). After adjusting for age, comorbidity and stage of dementia, predictors of excess disability in walking included using antidepressants (HR: 2.2; 95% CI: 1.02-4.6), and not using cognitive enhancers (HR: 2.6; 95% CI: 1.03-6.4).
Over half of walking disability in nursing home residents with middle-stage dementia may be modifiable. Creating supportive environments, ensuring access to cognitive enhancer drugs, and preventing and treating depression and the adverse effects of antidepressants, may help to reduce walking disability and excess disability.
越来越多的养老院痴呆症患者无法行走，这影响了他们的生活质量。本研究旨在评估行走障碍的发生率，并确定可能可纠正的预测因素。
在加拿大西部的 15 家养老院中，对一个队列进行了为期一年的两周一次随访。研究参与者包括 120 名处于中期阿尔茨海默氏症、血管性或混合性痴呆的能走动的居民。潜在残疾预测因素的标准化测量包括 Charlson 合并症指数、总体衰退量表和专业环境评估方案。行走障碍定义为使用轮椅前往餐厅用餐。
行走障碍的发生率为 40.8%（95%置信区间[CI]：32.7-50.2）。其中约一半（27.0%；95%CI：19.7-36.5）为过度残疾。痴呆程度较高且居住在支持性较差的养老院环境中的居民，行走障碍的风险增加（危险比[HR]：2.1；95%CI：1.2-3.8 和 HR：2.4；95%CI：1.3-4.4）。在调整年龄、合并症和痴呆阶段后，行走障碍的过度残疾预测因素包括使用抗抑郁药（HR：2.2；95%CI：1.02-4.6）和不使用认知增强剂（HR：2.6；95%CI：1.03-6.4）。
养老院中期痴呆症患者中，超过一半的行走障碍可能是可纠正的。创造支持性环境、确保获得认知增强剂药物、预防和治疗抑郁以及抗抑郁药的不良反应，可能有助于减少行走障碍和过度残疾。
