生活在社区边缘：认知障碍人群中断社区生活的相关因素。
Living on the edge of the community: factors associated with discontinuation of community living among people with cognitive impairment.
机构信息
Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, 35-2, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.
Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
出版信息
BMC Geriatr. 2021 Feb 19;21(1):131. doi: 10.1186/s12877-021-02084-2.
BACKGROUND
As Japanese society continues to age, the isolation of older people is increasing, and community living for people with cognitive impairment is becoming more difficult. However, the challenges faced by people with cognitive impairment living in the community have not been fully explored because of methodological difficulties. This study re-accessed people with cognitive impairment identified in a previous epidemiological survey to explore their current situation and the risk factors associated with all-cause discontinuation of community living.
METHODS
Under a community-based participatory framework, we examined a high-risk approach for people with cognitive impairment and a community action approach in parallel, to build a dementia-friendly community. For the high-risk approach, we achieved stepwise access to 7614 older residents, which enabled us to select and visit the homes of 198 participants with a Mini-Mental State Examination score < 24 in 2016. In 2019, we re-accessed these individuals. For the community action approach, we built a community space in the study area to build partnerships with community residents and community workers and were able to re-access participants using multiple methods.
RESULTS
We found that 126 (63.6%) participants had continued living in the same community, but 58 (29.3%) had discontinued community living. Of these, 18 (9.1%) had died, 18 (9.1%) were institutionalized, 9 (4.5%) were hospitalized, and 13 (6.6%) had moved out of the community. A multiple logistic regression analysis identified the following risk factors associated with discontinuation of community living: being certified under long-term care insurance, needing housing support, and needing rights protection.
CONCLUSIONS
Three years after the baseline survey, 29.3% of people with cognitive impairment had discontinued community living. Despite having cognitive impairment or living alone, older people were able to continue living in the community if their needs for housing support and rights protection were met. Both social interventions and medical interventions are important to build age-friendly communities.
TRIAL REGISTRATION
UMIN, UMIN000038189, Registered 3 October 2019, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000043521.
背景
随着日本社会老龄化的持续，老年人的孤立感日益增加，认知障碍者的社区生活也变得更加困难。然而，由于方法学上的困难，认知障碍者在社区中生活所面临的挑战尚未得到充分探索。本研究重新评估了先前流行病学调查中确定的认知障碍者，以探讨他们的现状以及与所有原因退出社区生活相关的风险因素。
方法
在基于社区的参与性框架下，我们同时采用高风险方法和社区行动方法来探索认知障碍者，以建立一个对痴呆症友好的社区。对于高风险方法，我们逐步接触了 7614 名老年居民，从而能够选择并访问 2016 年简易精神状态检查评分<24 的 198 名参与者的住所。2019 年，我们重新接触了这些人。对于社区行动方法，我们在研究区域内建立了一个社区空间，与社区居民和社区工作者建立伙伴关系，并能够通过多种方法重新接触参与者。
结果
我们发现，126 名（63.6%）参与者继续在同一社区生活，但 58 名（29.3%）已停止社区生活。其中，18 人（9.1%）死亡，18 人（9.1%）被收容，9 人（4.5%）住院，13 人（6.6%）搬出了社区。多变量逻辑回归分析确定了与社区生活中断相关的以下风险因素：长期护理保险认证、住房支持需求和权利保护需求。
结论
在基线调查三年后，29.3%的认知障碍者已停止社区生活。尽管存在认知障碍或独居，但若满足其住房支持和权利保护需求，老年人仍能够继续在社区生活。社会干预和医疗干预对于建设友好的老年社区都很重要。
试验注册
UMIN，UMIN000038189，于 2019 年 10 月 3 日注册，https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000043521。
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