入住养老院时的活动能力和认知功能 - 一项横断面研究。
Mobility and cognition at admission to the nursing home - a cross-sectional study.
机构信息
Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
出版信息
BMC Geriatr. 2018 Jan 30;18(1):30. doi: 10.1186/s12877-018-0724-4.
BACKGROUND
Earlier studies show that the main reasons for admission to long-term nursing home care are cognitive impairment and functional impairments of activities of daily life. However, descriptive evidence of mobility is scant. The aims of this study were to describe mobility at admission to nursing homes and to assess the association between mobility and degree of dementia.
METHODS
We included 696 residents at admission to 47 nursing homes in Norway. Inclusion criteria were expected stay for more than 4 weeks and 65 years or older. In addition, younger residents with dementia were included. Residents with life expectancy shorter than six weeks were excluded. Mobility was assessed using the Short Physical Performance Battery (SPPB) and the Nursing Home Life Space Diameter (NHLSD). The Clinical Dementia Rating Scale (CDR) was used to describe the degree of dementia. The associations between mobility and degree of dementia was analysed using the Chi-square and the Kruskal-Wallis test (KW-test). When the KW-test indicated a statistical significant difference, we proceeded with planned group comparisons with the Mann-Whitney U-test. In addition, we performed multiple linear regression analyses to control for potential confounders.
RESULTS
Forty-three percent of the residents were not able to perform the balance test in SPPB. Twenty-four percent of the residents were not able to walk four meters, while only 17.6% had a walking speed of 0.83 m/s or higher. Sixty-two percent of the residents were not able to rise from a chair or spent more than 60 s doing it. The median score on NHLSD area was 22 (IQR 17) and the median score on NHLSD dependency was 36 (IQR 26). Residents with severe dementia had significantly lower levels of mobility than residents with moderate dementia. Cognitive function was associated with SPPB and NHLSD dependency in the adjusted models.
CONCLUSION
Nursing home residents form a frail, but heterogeneous group both in terms of cognition and mobility at admission. Mobility was negatively associated with cognitive function, and residents with severe dementia had significantly lower levels of mobility than residents with moderate dementia.
背景
早期研究表明，入住长期护理院的主要原因是认知障碍和日常生活活动的功能障碍。然而，关于移动性的描述性证据很少。本研究的目的是描述入住护理院时的移动能力，并评估移动能力与痴呆程度之间的关系。
方法
我们纳入了挪威 47 家护理院的 696 名入住患者。纳入标准为预计住院时间超过 4 周且年龄在 65 岁或以上。此外，还纳入了有痴呆症的年轻患者。预期寿命少于 6 周的患者被排除在外。使用短体适能表现测试（SPPB）和护理院生活空间直径（NHLSD）评估移动能力。使用临床痴呆评定量表（CDR）描述痴呆程度。使用卡方检验和 Kruskal-Wallis 检验（KW 检验）分析移动能力与痴呆程度之间的关系。当 KW 检验显示存在统计学显著差异时，我们进行了计划的组间比较，使用 Mann-Whitney U 检验。此外，我们还进行了多元线性回归分析，以控制潜在的混杂因素。
结果
43%的居民无法完成 SPPB 的平衡测试。24%的居民无法行走 4 米，而只有 17.6%的居民行走速度为 0.83 m/s 或更高。62%的居民无法从椅子上站起来或花超过 60 秒的时间站起来。NHLSD 区域的中位数评分为 22（IQR 17），NHLSD 依赖的中位数评分为 36（IQR 26）。严重痴呆的居民的移动能力明显低于中度痴呆的居民。在调整后的模型中，认知功能与 SPPB 和 NHLSD 依赖相关。
结论
入住护理院的居民在认知和入院时的移动能力方面都是一个脆弱但具有异质性的群体。移动能力与认知功能呈负相关，严重痴呆的居民的移动能力明显低于中度痴呆的居民。
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