Domaine de la Source, Roquefort la Bédoule, France.
Department of Clinical Research, State Gerontological Center, Marseille, France; Silvermed Institute, State Geriatric Center, Marseille, France; Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France.
J Am Med Dir Assoc. 2019 Mar;20(3):377-381. doi: 10.1016/j.jamda.2018.09.015. Epub 2018 Nov 16.
To determine whether environmental rearrangements of the long-term care nursing home can affect disruptive behavioral and psychological symptoms of dementia (BPSD) in residents with dementia.
Prospective 6-month study.
The study was conducted before (phase 1) and after (phase 2) environmental rearrangements [skylike ceiling tiles in part of the shared premises, progressive decrease of the illuminance at night together with soothing streaming music, reinforcement of the illuminance during the day, walls painted in light beige, oversized clocks in corridors, and night team clothes color (dark blue) different from that of the day team (sky blue)].
All of the patients (n = 19) of the protected unit were included in the study. They were aged 65 years or older and had an estimated life expectancy above 3 months.
Number and duration of disruptive BPSD were systematically collected and analyzed over 24 hours or during late hours (6:00-12:00 pm) during each 3-month period.
There was no significant change in the patients' dependency, risk of fall, cognitive or depression indexes, or treatment between phase 1 and 2. Agitation/aggression and screaming were observed mainly outside the late hours as opposed to wandering episodes that were noticed essentially within the late hours. The number of patients showing wandering was significantly lower over 24 hours during phase 2. The number of agitation/physical aggression, wandering, and screaming and the mean duration of wandering episodes were significantly (P = .039, .002, .025, and .026 respectively) decreased over 24 hours following environmental rearrangements. Similarly, a significant reduction in the number and mean duration of wandering was noticed during the late hours (P = .031 and .007, respectively).
Our study demonstrates that BPSD prevalence can be reduced following plain environmental rearrangements aimed at improving spatial and temporal orientation.
确定长期护理养老院的环境重新布置是否会影响痴呆患者的行为和心理症状障碍（BPSD）。
前瞻性 6 个月研究。
该研究在环境重新布置之前（第 1 阶段）和之后（第 2 阶段）进行[部分共享场所采用天顶瓷砖、夜间逐渐降低光照度同时播放舒缓的音乐流、白天增强光照度、墙壁涂成浅米色、走廊上安装超大时钟以及夜班团队的服装颜色（深蓝色）与白班团队（天蓝色）不同]。
受保护单元的所有患者（n=19）均纳入研究。他们年龄在 65 岁或以上，预计寿命超过 3 个月。
在每个 3 个月期间，每天 24 小时或在深夜（下午 6:00-12:00）系统收集和分析干扰性 BPSD 的次数和持续时间。
在第 1 阶段和第 2 阶段之间，患者的依赖性、跌倒风险、认知或抑郁指数或治疗没有显著变化。激越/攻击和尖叫主要发生在深夜以外，而徘徊发作主要发生在深夜内。在第 2 阶段，24 小时内出现徘徊的患者数量显著减少。激越/身体攻击、徘徊、尖叫的患者数量以及徘徊发作的平均持续时间在 24 小时内显著降低（P=.039、.002、.025 和.026），环境重新布置后夜间的发生率也显著降低（P=.031 和.007）。
我们的研究表明，通过旨在改善空间和时间定向的简单环境重新布置，可以降低 BPSD 的发生率。
