Université Paris-Saclay, UVSQ, Inserm, CESP, Echappement aux anti-infectieux et pharmaco-épidémiologie, Montigny-le-Bretonneux, France.
Observatoire régional de santé Île-de-France, Département de l'Institut Paris Région, Paris, France.
PLoS One. 2022 Jun 22;17(6):e0270258. doi: 10.1371/journal.pone.0270258. eCollection 2022.
The adaptation of living environments can preserve functional independence among older people. A few studies have suggested that this would only benefit the most impaired. But conceptual models theorize that environmental pressure gradually increases with functional decline.
We examined (1) how far different environmental barriers increased difficulties and favoured resort to assistance; (2) at what stage in functional decline environmental barriers begin to matter.
We used the French cross-sectional survey CARE (2015), including 7,451 participants (60+) with at least one severe functional limitation (FL). Multinomial logistic regressions models were used to compare predicted probabilities for outdoor activities of daily living (OADL) difficulties (no OADL difficulties; difficulties but without assistance; use of assistance) among individuals with and without environmental barriers (self-reported or objective), in relation to the number of FLs.
Poor-quality pedestrian areas and lack of places to rest were associated with a higher probability of experiencing OADL difficulties, whatever the number of FLs; the association increased with the number of FLs. Up to 6 FLs, individuals with these barriers were more likely to report difficulties without resorting to assistance, with a decreasing association. Living in cities/towns with high diversity of food outlets was associated with a lower probability of reporting assistance, whatever the number of FLs, but with a decreasing association.
Overall, the results suggest that environmental barriers increasingly contribute to OADL difficulties with the number of FLs. Conclusions differed as to whether they tended to favour resort to assistance, but there was a clear association with food outlets, which decreased with impairment severity. The adaptation of living environments could reduce difficulties in performing activities from the early stages of decline to the most severe impairment. However, the most deteriorated functional impairments seem to generate resort to assistance whatever the quality of the environment.
适应生活环境可以保持老年人的功能独立性。一些研究表明，这只会使最受损的人群受益。但概念模型理论认为，环境压力会随着功能下降而逐渐增加。
我们检验了（1）不同环境障碍增加困难并促使寻求帮助的程度；（2）在功能下降的哪个阶段环境障碍开始起作用。
我们使用了法国的横断面调查 CARE（2015 年），其中包括 7451 名（60 岁以上）至少有一项严重功能限制（FL）的参与者。使用多项逻辑回归模型比较了有和没有环境障碍（自我报告或客观）的个体之间，在户外活动日常生活（OADL）困难（无 OADL 困难；有困难但无需帮助；需要帮助）的预测概率，与 FL 的数量有关。
较差的行人区和缺乏休息场所与 OADL 困难的发生概率较高有关，无论 FL 的数量如何；这种关联随着 FL 的数量增加而增加。在有 6 项 FL 的情况下，有这些障碍的个体更有可能在不寻求帮助的情况下报告困难，但关联逐渐减弱。居住在食品供应多样化程度高的城市/城镇与报告需要帮助的可能性较低有关，无论 FL 的数量如何，但关联逐渐减弱。
总体而言，结果表明，环境障碍随着 FL 的数量增加，对 OADL 困难的贡献越来越大。关于它们是否倾向于促使寻求帮助的结论有所不同，但与食品供应有明确的关联，随着功能障碍的严重程度而减少。生活环境的适应可以减少从功能下降的早期阶段到最严重损伤的活动困难。然而，无论环境质量如何，最严重的功能损伤似乎都需要寻求帮助。
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