一个交叉滞后面板模型，用于测试住院期间身体活动对患有痴呆症的老年人1个月和6个月出院时身体活动及不良事件的影响。
A Cross-Lagged Panel Model Testing the Impact of Physical Activity During Hospitalization on 1- and 6-Month Discharge Physical Activity and Adverse Events Among Older Adults With Dementia.
作者信息
Zhu Shijun, Resnick Barbara, Boltz Marie, Galik Elizabeth, McPherson Rachel, Kuzmik Ashley, Wells Chris, Shim Soyeon, Lee Eunji
机构信息
University of Maryland School of Nursing, Baltimore, MD, USA.
University of Maryland School of Nursing, Baltimore, MD, USA.
出版信息
J Am Med Dir Assoc. 2025 Jul 9:105767. doi: 10.1016/j.jamda.2025.105767.
OBJECTIVE
The objective of this study was to examine the effects of physical activity during hospital stay on falls, emergency room visits, and rehospitalizations among older patients with dementia at 1 and 6 months post discharge.
DESIGN
This is a secondary data analysis. Bidirectional analysis using panel data from a cluster randomized clinical trial was utilized.
SETTING AND PARTICIPANTS
The sample comprised 455 older adults with dementia from a clustered randomized clinical trial among 12 hospitals in 2 east coast states.
METHODS
The bidirectional relationships between physical activity at 1 and 6 months and falls, emergency room visits, and rehospitalizations at 1 and 6 months post discharge and their relations with physical activity at discharge were assessed using cross-lagged panel models, accounting for the autoregression of physical activity and adverse events over time. Age, race, gender, cognitive status, admission location, comorbidity, and intervention groups were controlled in the modeling.
RESULTS
Physical activity at hospitalization discharge showed autoregressive associations for the 3 time points. Patients with a higher level of physical activity at discharge had a lower chance of falling (β = -0.250, SE = 0.094, OR = 0.779, P = .008) and rehospitalizations (β = -0.228, SE = 0.092, OR = 0.796, P = .013) within 1 month post discharge. Falls, emergency room visits, or rehospitalizations at 1 month were not significantly associated with physical activity, or any adverse events at 6 months.
CONCLUSIONS AND IMPLICATIONS
The findings from this study highlighted the significance and value of engaging older adults, particularly those living with dementia, in physical activity when hospitalized, as this reduced the likelihood of adverse events such as falls and rehospitalization at least in the first month post discharge.
目的
本研究的目的是调查老年痴呆患者住院期间的身体活动对出院后1个月和6个月时跌倒、急诊就诊及再次住院情况的影响。
设计
这是一项二次数据分析。采用了来自一项整群随机临床试验的面板数据进行双向分析。
设置与参与者
样本包括来自东海岸两个州12家医院的一项整群随机临床试验中的455名老年痴呆患者。
方法
使用交叉滞后面板模型评估出院后1个月和6个月时身体活动与跌倒、急诊就诊及再次住院之间的双向关系，以及它们与出院时身体活动的关系，同时考虑身体活动和不良事件随时间的自回归情况。在建模过程中对年龄、种族、性别、认知状态、入院地点、合并症和干预组进行了控制。
结果
出院时的身体活动在3个时间点显示出自回归关联。出院时身体活动水平较高的患者在出院后1个月内跌倒（β = -0.250，标准误 = 0.094，比值比 = 0.779，P = .008）和再次住院（β = -0.228，标准误 = 0.092，比值比 = 0.796，P = .013）的可能性较低。1个月时的跌倒、急诊就诊或再次住院与6个月时的身体活动或任何不良事件均无显著关联。
结论与启示
本研究结果强调了让老年人，尤其是老年痴呆患者在住院期间进行身体活动的重要性和价值，因为这至少在出院后的第一个月降低了跌倒和再次住院等不良事件的发生可能性。
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