Yamada Yukari, Denkinger Michael D, Onder Graziano, Finne-Soveri Harriet, van der Roest Henriëtte, Vlachova Martina, Richter Tomas, Gindin Jacob, Bernabei Roberto, Topinkova Eva
Department of Geriatrics, First faculty of Medicine, Charles University, Prague, Czech Republic; Department of Nursing, Faculty of Health Sciences, Palacky University, Olomouc, Czech Republic.
Agaplesion Bethesda Clinic, Geriatric Center Ulm/Alb-Donau, University of Ulm, Ulm, Germany.
J Am Med Dir Assoc. 2015 Apr;16(4):329-33. doi: 10.1016/j.jamda.2014.11.006. Epub 2014 Dec 15.
To investigate if dual sensory impairment (DSI) in the form of a combined visual and hearing impairment is associated with the onset of behavioral symptoms in nursing homes.
A total of 1524 nursing home residents without behavioral symptoms at baseline followed for 12 months in 59 nursing homes from the Czech Republic, England, Finland, France, Germany, Israel, Italy, and The Netherlands. The interRAI instrument for long-term care facilities was assessed by trained staff at baseline and 12 months later.
Altogether, 11% of residents had a new onset of behavioral symptoms (wandering, verbal abuse, physical abuse, socially inappropriate behavior, public disrobing, and resisting care) at 12-month follow-up. In multivariate analyses adjusted for potential confounders, DSI residents had significantly higher incidence of new behavioral symptoms at 12-month follow-up, irrespective of the severity of vision and hearing impairments [odds ratio (OR) = 2.1, 95% confidence interval (CI) = 1.3:3.4 for mild DSI, OR = 2.5, 95% CI = 1.6:4.0 for moderate DSI, and OR = 2.1, 95% CI = 1.2:3.7 for severe DSI] compared with residents without sensory impairment. Among the different types of symptoms, only abusive behaviors were less likely to be associated with DSI.
This study provides evidence that DSI could play a significant role in the development of behavioral symptoms in nursing home residents. More attention should be paid to DSI even when each of vision and hearing function is only minimally impaired.
调查以视觉和听力联合损伤形式存在的双重感官障碍（DSI）是否与养老院中行为症状的发作有关。
来自捷克共和国、英国、芬兰、法国、德国、以色列、意大利和荷兰的59家养老院中，共有1524名基线时无行为症状的养老院居民接受了为期12个月的随访。长期护理机构的interRAI工具由经过培训的工作人员在基线时和12个月后进行评估。
在12个月的随访中，共有11%的居民出现了新的行为症状（徘徊、言语虐待、身体虐待、社交不当行为、当众脱衣和抗拒护理）。在针对潜在混杂因素进行调整的多变量分析中，DSI居民在12个月随访时出现新行为症状的发生率显著更高，无论视力和听力损伤的严重程度如何[轻度DSI的比值比（OR）=2.1，95%置信区间（CI）=1.3:3.4；中度DSI的OR=2.5，95%CI=1.6:4.0；重度DSI的OR=2.1，95%CI=1.2:3.7]，与无感官损伤的居民相比。在不同类型的症状中，只有虐待行为与DSI的关联较小。
本研究提供了证据表明DSI可能在养老院居民行为症状的发展中起重要作用。即使视力和听力功能各自仅有轻微损伤，也应更加关注DSI。
