Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA.
J Geriatr Phys Ther. 2013 Apr-Jun;36(2):78-86. doi: 10.1519/JPT.0b013e318268de7f.
The prevalence of functional mobility limitations and falls is higher in people with dementia compared with cognitively healthy older adults, and both are associated with gait and motor impairments. The aims of this study were to examine concurrent validity of physical performance assessments and spatiotemporal gait measures in older adults with advanced dementia and to prospectively examine their relationship to functional mobility limitations and falls over a 4-month period.
Thirty-one older adults living in dementia-specific assisted living residences participated. Correlations were examined between a modified Berg Balance Scale (mod-Berg), the Short Physical Performance Battery (SPPB), and spatiotemporal gait measures using the GAITRite Walkway system. Over 4-months, functional mobility limitations were rated, and falls were recorded by nursing supervisors. Differences in functional mobility limitations and falls were examined in relation to baseline balance and gait measures.
Partial correlations between spatiotemporal gait measures and the mod-Berg as well as the SPPB were statistically significant (P < .05) after adjusting for age and Mini-Mental State Examination scores. Participants with low functional mobility ratings had significantly lower scores on the mod-Berg (P ≤ .001) and SPPB (P ≤ .001). They also demonstrated slower gait speed, lower cadence, higher stride time variability, and a greater percentage of gait cycle in double support (P ≤ .01). Participants with at least 1 fall, compared with those who did not fall, had lower scores on the mod-Berg (P = .02), lower cadence (P = .048), and greater stride length variability (P = .035).
The mod-Berg and SPPB were strongly correlated with reliable gait measures associated with instability and increased fall risk. The modified Berg Balance Scale demonstrates potential as a predictor of falls in older adults living in dementia-specific assisted living.
The results of this study provide support for the application of brief physical performance assessments by physical therapists to identify functional mobility limitations and fall risk in older adults with advanced dementia.
与认知健康的老年人相比，痴呆症患者的功能性移动受限和跌倒的发生率更高，且两者均与步态和运动损伤有关。本研究的目的是检查身体表现评估和时空步态测量在患有晚期痴呆症的老年人中的同时效度，并前瞻性地检查它们在 4 个月内与功能性移动受限和跌倒的关系。
31 名居住在痴呆症特定辅助生活住所的老年人参与了该研究。使用 GAITRite 步道系统检查改良 Berg 平衡量表（mod-Berg）、简短体能状况测试（SPPB）和时空步态测量之间的相关性。在 4 个月期间，由护理主管对功能性移动受限进行评估，并记录跌倒情况。根据基线平衡和步态测量值，检查功能性移动受限和跌倒之间的差异。
在调整年龄和简易精神状态检查表得分后，时空步态测量值与 mod-Berg 和 SPPB 之间的部分相关具有统计学意义（P<0.05）。功能移动受限评分较低的参与者，其 mod-Berg（P≤0.001）和 SPPB（P≤0.001）得分明显较低。他们的步态速度也较慢，步频较低，步长时间变异性较高，双支撑阶段的步态周期百分比较大（P≤0.01）。与未跌倒的参与者相比，至少发生 1 次跌倒的参与者的 mod-Berg（P=0.02）、步频（P=0.048）和步长变异性较大（P=0.035）。
mod-Berg 和 SPPB 与不稳定和增加跌倒风险相关的可靠步态测量值密切相关。改良 Berg 平衡量表在识别患有痴呆症的辅助生活老年人的功能性移动受限和跌倒风险方面具有潜在应用价值。
本研究结果为物理治疗师应用简短的身体表现评估来识别患有晚期痴呆症的老年人的功能性移动受限和跌倒风险提供了支持。
