University of Alberta, Edmonton, Alberta, Canada.
J Am Geriatr Soc. 2012 Sep;60(9):1624-31. doi: 10.1111/j.1532-5415.2012.04116.x.
To estimate the relative effects of environment, comorbidities, stage of dementia and other variables on disability onset.
A 1-year prospective cohort study was conducted in which the walking and eating abilities of long-term care residents were observed fortnightly. Structural equation modeling was used to assess the contributions of individual and environmental factors to the onset of disability.
Fifteen nursing homes in western Canada.
One hundred twenty residents with middle-stage Alzheimer disease or related dementia.
Environmental quality was assessed using the Professional Environmental Assessment Protocol, comorbidity using the Charlson Comorbidity Index, and stage of dementia using the Global Deterioration Scale.
More-advanced baseline dementia had a direct effect on onset of walking and eating disability (standardized maximum likelihood estimate (SMLE) = 0.24, P = .006). Resident environment (SMLE = -0.25, P = .007) and comorbidities (SMLE = 0.32, P < .001) influenced disability onset approximately as strongly as stage of dementia. Smaller and publicly owned facilities provided superior environmental quality, which indirectly contributed to a delay in onset of walking and eating disability.
Environmental quality and extent of comorbidity are at least as important as progression of dementia in initiating or delaying the onset of disability.
评估环境、合并症、痴呆阶段和其他变量对残疾发生的相对影响。
进行了一项为期 1 年的前瞻性队列研究，每两周观察长期护理居民的行走和进食能力。结构方程模型用于评估个体和环境因素对残疾发生的贡献。
加拿大西部的 15 家养老院。
120 名患有中度阿尔茨海默病或相关痴呆症的居民。
使用专业环境评估方案评估环境质量，使用 Charlson 合并症指数评估合并症，使用全球衰退量表评估痴呆阶段。
基线时更严重的痴呆症对行走和进食残疾的发生有直接影响（标准化最大似然估计值（SMLE）= 0.24，P =.006）。居民环境（SMLE = -0.25，P =.007）和合并症（SMLE = 0.32，P <.001）对残疾发生的影响与痴呆阶段大致相同。较小和公有制的设施提供了更好的环境质量，这间接导致行走和进食残疾发生的延迟。
环境质量和合并症的严重程度至少与痴呆症的进展一样重要，会引发或延迟残疾的发生。
