认知障碍在老年痴呆症患者日常生活基本活动详细过程中的差异。
Differences by cognitive impairment in detailed processes for basic activities of daily living in older adults with dementia.
机构信息
Doctoral Program of Clinical Neuropsychiatry, Graduate School of Health Sciences, Kagoshima University, Kagoshima, Japan.
Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
出版信息
Psychogeriatrics. 2022 Nov;22(6):859-868. doi: 10.1111/psyg.12894. Epub 2022 Oct 2.
BACKGROUND
Impairment of activities of daily living in patients with dementia has a fundamental and lasting impact on their quality of life and requires a detailed assessment. This study investigated to clarify characteristic of basic activities of daily living (BADL) processes with the severity of cognitive impairment in community-dwelling older adults with dementia using the Process Analysis of Daily Activity for Dementia (PADA-D).
METHODS
Participants were recruited from outpatient departments of 24 hospitals, daycare centres, and home rehabilitation services in Japan. The severity of cognitive impairment was determined using the Mini-mental State Examination (mild: score ≥ 20; moderate: 10 ≤ score < 20; severe: score < 10). Patient's BADL were assessed according to the PADA-D by observation of the occupational therapist and interviews with family members. Basic information and the scores of BADL items of the PADA-D were compared between the three groups. Subsequently, we compared the percentage of independent or non-independent processes included in the sub-items of BADL in the PADA-D.
RESULTS
A total of 143 patients were included in the analysis. Performance on BADL was shown to decrease significantly with increasing severity of cognitive impairment. The percentage of all BADL processes performed ranged from 58% to 100% in mild, 38% to 97% in moderate, and 0% to 88% in severe. Some of the processes included in BADL of PADA-D showed no significant differences in independence between the three groups.
DISCUSSION/CONCLUSION: Most BADL processes differed with respect to different independence rates depending on the severity of cognitive impairment of the older adults with dementia. However, some BADL processes were not associated with the severity of cognitive impairment. Our findings may suggest that a detailed BADL assessment of patients with dementia is useful in terms of caregiver education to avoid excessive caregiving and in predicting BADL impairment.
背景
痴呆患者日常生活活动能力受损对其生活质量有根本和持久的影响，需要进行详细评估。本研究使用痴呆患者日常生活活动的过程分析（PADA-D），调查了社区居住的痴呆老年患者认知障碍严重程度与基本日常生活活动（BADL）过程特征之间的关系。
方法
参与者从日本的 24 家医院的门诊部门、日托中心和家庭康复服务中招募。认知障碍的严重程度使用简易精神状态检查（轻度：得分≥20；中度：10≤得分<20；重度：得分<10）来确定。根据职业治疗师的观察和对家庭成员的访谈，使用 PADA-D 评估患者的 BADL。比较三组患者的基本信息和 PADA-D 的 BADL 项目得分。随后，我们比较了 PADA-D 的 BADL 子项目中包含的独立或非独立过程的百分比。
结果
共有 143 名患者纳入分析。随着认知障碍严重程度的增加，BADL 的表现明显下降。轻度认知障碍患者的所有 BADL 过程的完成率为 58%至 100%，中度认知障碍患者为 38%至 97%，重度认知障碍患者为 0%至 88%。PADA-D 的 BADL 中的一些过程在三组之间的独立性方面没有显著差异。
讨论/结论：大多数 BADL 过程的独立性因认知障碍严重程度的不同而不同。然而，一些 BADL 过程与认知障碍的严重程度无关。我们的发现表明，对痴呆患者进行详细的 BADL 评估在照顾者教育方面是有用的，可以避免过度照顾，并预测 BADL 受损。
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