家庭健康物理治疗中的认知障碍患病率。
Prevalence of cognitive impairment in home health physical therapy.
机构信息
Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, California, USA.
Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.
出版信息
J Am Geriatr Soc. 2024 Mar;72(3):802-810. doi: 10.1111/jgs.18715. Epub 2023 Dec 28.
BACKGROUND
The prevalence of cognitive impairment in home health physical therapy (HHPT) is unknown. We sought to identify the prevalence of cognitive impairment, including cognitive impairment no dementia (CIND) and dementia, among older adults who used HHPT, and if cognitive impairment prevalence was higher among those with HHPT-relevant characteristics.
METHODS
For our cross-sectional analysis, we identified 963 fee-for-service Medicare beneficiaries with HHPT claims (>85 years old: 28.8%, women: 63.7%, non-Hispanic White: 82.1%) in the 2014 and 2016 waves of the Health and Retirement Study (HRS) and used a validated algorithm to categorize cognitive status as normal, CIND, or dementia. We estimated the population prevalence and calculated age, gender, race/ethnicity adjusted odds ratio (aOR) of CIND and dementia for characteristics relevant to HHPT service delivery including depression, walking difficulty, fall history, incontinence, moderate-vigorous physical activity (MVPA) ≤1x/week, and community-initiated HHPT using multinomial logistic regression.
RESULTS
The population prevalence of cognitive impairment was 46.4% (CIND: 27.3%, dementia: 19.1%). The prevalence of cognitive impairment was greater among those with depression (46.7% vs. 39.5%), difficulty walking across the room (58.9% vs. 41.8%), fall history (49.1% vs. 42.9%), MVPA ≤1x/week (50.0% vs. 38.0%), and community-initiated HHPT (55.2% vs. 40.2%). Compared to normal cognitive status, the odds of cognitive impairment were greater for those with MVPA≤1x/week (CIND: aOR = 1.57 [95% CI: 1.05-2.33], dementia: aOR = 2.55 [95% CI: 1.54-4.22]), depression (dementia: aOR = 1.99 [95% CI: 1.19-3.30]), difficulty walking across the room (dementia: aOR = 2.54 [95% CI: 1.40-4.60]), fall history (dementia: aOR = 1.85 [95% CI: 1.20-2.83]), and community-initiated HHPT (dementia: aOR = 1.72 (95% CI: 1.13-2.61]).
CONCLUSION
There is a high prevalence of CIND and dementia in HHPT, and no characteristics had a low prevalence of cognitive impairment. Physical therapists should be ready to identify cognitive impairment and adapt home health service delivery for this vulnerable population of older adults.
背景
家庭健康物理治疗（HHPT）中认知障碍的患病率尚不清楚。我们旨在确定使用 HHPT 的老年人中认知障碍（包括认知障碍但无痴呆症[CIND]和痴呆症）的患病率，以及 HHPT 相关特征是否会导致更高的认知障碍患病率。
方法
我们对 2014 年和 2016 年健康与退休研究（HRS）中的 963 名接受 HHPT 服务的收费服务医疗保险受益人（>85 岁：28.8%，女性：63.7%，非西班牙裔白人：82.1%）进行了横断面分析，并使用经过验证的算法将认知状态归类为正常、CIND 或痴呆症。我们估计了人群患病率，并使用多变量逻辑回归计算了与 HHPT 服务提供相关的特征（抑郁、行走困难、跌倒史、尿失禁、每周进行 1 次或更少的中高强度体力活动[MVPA]和社区发起的 HHPT）的 CIND 和痴呆症的年龄、性别、种族/族裔调整比值比（aOR）。
结果
认知障碍的人群患病率为 46.4%（CIND：27.3%，痴呆症：19.1%）。患有抑郁症（46.7% vs. 39.5%）、行走困难（58.9% vs. 41.8%）、跌倒史（49.1% vs. 42.9%）、每周进行 1 次或更少 MVPA（50.0% vs. 38.0%）和社区发起的 HHPT（55.2% vs. 40.2%）的人认知障碍的患病率更高。与认知正常相比，每周进行 1 次或更少 MVPA（CIND：aOR=1.57 [95%CI：1.05-2.33]，痴呆症：aOR=2.55 [95%CI：1.54-4.22]）、抑郁（痴呆症：aOR=1.99 [95%CI：1.19-3.30]）、行走困难（痴呆症：aOR=2.54 [95%CI：1.40-4.60]）、跌倒史（痴呆症：aOR=1.85 [95%CI：1.20-2.83]）和社区发起的 HHPT（痴呆症：aOR=1.72 [95%CI：1.13-2.61]）的认知障碍的可能性更大。
结论
HHPT 中 CIND 和痴呆症的患病率很高，而且没有任何特征的认知障碍患病率较低。物理治疗师应随时准备识别认知障碍，并为这一脆弱的老年人群调整家庭健康服务的提供。
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