Ullrich Phoebe, Werner Christian, Bongartz Martin, Eckert Tobias, Abel Bastian, Schönstein Anton, Kiss Rainer, Hauer Klaus
AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Germany.
Center of Geriatric Medicine, Heidelberg University, Germany.
J Gerontol A Biol Sci Med Sci. 2021 Oct 13;76(11):1988-1996. doi: 10.1093/gerona/glaa254.
Community-dwelling older persons with cognitive impairment (CI) following discharge from geriatric rehabilitation are at high risk of losing life-space mobility (LSM). Interventions to improve their LSM are, however, still lacking. The aim of this study was to evaluate the effects of a CI-specific, home-based physical training and activity promotion program on LSM.
Older persons with mild-to-moderate CI (Mini-Mental State Examination: 17-26 points) discharged home from rehabilitation were included in this double-blinded, randomized, placebo-controlled trial with a 12-week intervention period and 12-week follow-up period. The intervention group received a CI-specific, home-based strength, balance, and walking training supported by tailored motivational strategies. The control group received a placebo activity. LSM was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment, including a composite score for LSM and 3 subscores for maximal, equipment-assisted, and independent life space. Mixed-model repeated-measures analyses were used.
One hundred eighteen participants (82.3 ± 6.0 years) with CI (Mini-Mental State Examination: 23.3 ± 2.4) were randomized. After the intervention, the home-based training program resulted in a significant benefit in the Life-Space Assessment in Persons with Cognitive Impairment composite scores (b = 8.15; 95% confidence interval: 2.89-13.41; p = .003) and independent life-space subscores (b = 0.39; 95% confidence interval: 0.00-0.78; p = .048) in the intervention group (n = 63) compared to control group (n = 55). Other subscores and follow-up results were not significantly different.
The home-based training program improved LSM and independent life space significantly in this vulnerable population. Effects were not sustained over the follow-up. The program may represent a model for improved transition from rehabilitation to the community to prevent high risk of LSM restriction.
老年康复出院后的社区认知障碍（CI）老年人失去生活空间移动性（LSM）的风险很高。然而，改善其LSM的干预措施仍然缺乏。本研究的目的是评估一项针对CI的家庭体育锻炼和活动促进计划对LSM的影响。
本双盲、随机、安慰剂对照试验纳入了康复后出院回家的轻度至中度CI老年人（简易精神状态检查表：17 - 26分），干预期为12周，随访期为12周。干预组接受了针对CI的家庭力量、平衡和步行训练，并辅以量身定制的激励策略。对照组接受安慰剂活动。通过认知障碍者生活空间评估来评估LSM，包括LSM综合评分以及最大、设备辅助和独立生活空间的3个子评分。采用混合模型重复测量分析。
118名CI参与者（82.3 ± 6.0岁，简易精神状态检查表：23.3 ± 2.4）被随机分组。干预后，与对照组（n = 55）相比，干预组（n = 63）的家庭训练计划在认知障碍者生活空间评估综合评分（b = 8.15；95%置信区间：2.89 - 13.41；p = .003）和独立生活空间子评分（b = 0.39；95%置信区间：0.00 - 0.78；p = .048）方面产生了显著益处。其他子评分和随访结果无显著差异。
家庭训练计划在这一脆弱人群中显著改善了LSM和独立生活空间。随访期间效果未持续。该计划可能代表了一种改善从康复到社区过渡以预防LSM受限高风险的模式。
