Department of Health Care Administration, Chang Jung Christian University, Tainan, Taiwan.
J Am Geriatr Soc. 2010 Dec;58(12):2275-83. doi: 10.1111/j.1532-5415.2010.03173.x. Epub 2010 Nov 18.
To determine whether cognition moderates the association between facility-level characteristics and individual-level impairments and activity of daily living (ADL) dependency.
Longitudinal cohort study.
Nursing homes (NHs) in Minnesota.
Four thousand nine hundred forty-two NH residents admitted to 377 Minnesota NHs during 2004 were followed for 4 to 8 months.
According to the Minimum Data Set (MDS) Cognition Scale 3,132 residents had high cognitive function, and 1,810 had low cognitive function. Total ADL score and scores on three ADL tasks at follow-up were used as outcome variables. MDS-derived impairment measures at admission of pain, depression, incontinence, balance dysfunction, and fall history were used to predict ADL changes. Fifteen resident-level and eight facility-level control variables were included in all four ADL models.
Effects of NHs and impairments on ADLs tended to be weaker for residents with low cognitive function. Bladder incontinence significantly predicted more dependence in total ADLs, toileting, and personal hygiene in both cognitive groups. Balance dysfunction significantly predicted worse total ADLs, toileting, and personal hygiene in the high-cognition group but only worse toileting function in the low-cognition group. In neither subgroup did any impairment predict worse eating function. Cognition did not modify the relationships between pain, depression, and recent falls and ADLs.
Current NH environments and care processes may be inadequate to facilitate ADL changes for residents with severe cognitive impairment. More innovative structural designs, higher staffing levels, and better care processes may be indicated.
确定认知能力是否会调节设施层面特征与个体层面损伤以及日常生活活动（ADL）依赖之间的关联。
纵向队列研究。
明尼苏达州的养老院。
2004 年期间入住明尼苏达州 377 家养老院的 4942 名养老院居民，随访时间为 4 至 8 个月。
根据最低数据集合（MDS）认知量表 3，132 名居民认知功能良好，1810 名居民认知功能较差。总 ADL 评分和随访时的三项 ADL 任务评分被用作结果变量。入院时 MDS 得出的疼痛、抑郁、尿失禁、平衡功能障碍和跌倒史等损伤测量值用于预测 ADL 变化。在所有四个 ADL 模型中，共纳入了 15 个居民层面和 8 个设施层面的控制变量。
对于认知功能较差的居民，养老院和损伤对 ADL 的影响往往较弱。膀胱失禁在两个认知组中均显著预测了总 ADL、如厕和个人卫生方面的更高依赖性。平衡功能障碍在认知功能较好的组中显著预测了总 ADL、如厕和个人卫生方面的更差结果，但仅在认知功能较差的组中预测了如厕功能更差。在任何亚组中，都没有任何损伤会预测更差的进食功能。认知能力并没有改变疼痛、抑郁和近期跌倒与 ADL 之间的关系。
当前的养老院环境和护理流程可能不足以促进认知功能严重受损的居民的 ADL 变化。可能需要更具创新性的结构设计、更高的人员配备水平和更好的护理流程。
