Gill T M, Richardson E D, Tinetti M E
Department of Medicine, Yale University School of Medicine, USA.
J Gerontol A Biol Sci Med Sci. 1995 Sep;50(5):M235-41. doi: 10.1093/gerona/50a.5.m235.
Although cognitive impairment has been implicated as a risk factor for dependence in activities of daily living (ADLs), little is known about the risk of ADL dependence among older adults with cognitive impairment.
Among a representative cohort of 1,103 community-living adults aged 72 years and older, we evaluated the 237 subjects with mild to moderate cognitive impairment who were independent in their basic ADLs. All cohort members had undergone a comprehensive assessment, including a battery of qualitative and timed performance tests.
ADL dependence developed in 31 (16%) of the 197 subjects who had complete data at the 1-year follow-up. Of the self-reported characteristics, only three--living alone, not being currently married, and having an impairment in IADL function--were significantly associated (p < .05) with the onset of ADL dependence. Several simple tests of physical performance, on the other hand, were strongly associated with the development of ADL dependence. Both timed and qualitative performance tests successfully identified subjects at risk for ADL dependence. A combination of two performance tests--rapid gait and qualitative chair stands--was particularly effective at distinguishing subjects at low (4.7%) and high (34%-39%) risk for ADL dependence.
Among community-living older adults with mild to moderate cognitive impairment, the risk of ADL dependence is high but varies considerably depending on how well and how quickly one can perform simple tasks of everyday function. An assessment strategy based on tests of physical performance may allow clinicians to identify subgroups of cognitively impaired elders at low and high risk for ADL dependence.
尽管认知障碍被认为是日常生活活动（ADL）依赖的一个风险因素，但对于认知障碍的老年人中ADL依赖的风险知之甚少。
在一个由1103名72岁及以上社区居住成年人组成的代表性队列中，我们评估了237名在基本ADL方面独立的轻度至中度认知障碍受试者。所有队列成员都接受了全面评估，包括一系列定性和定时性能测试。
在197名在1年随访时有完整数据的受试者中，31名（16%）出现了ADL依赖。在自我报告的特征中，只有三个——独居、目前未婚以及IADL功能受损——与ADL依赖的发生显著相关（p < 0.05）。另一方面，一些简单的身体性能测试与ADL依赖的发展密切相关。定时和定性性能测试都成功地识别出有ADL依赖风险的受试者。两项性能测试——快速步态和定性从椅子上站起——的组合在区分ADL依赖低风险（4.7%）和高风险（34%-39%）的受试者方面特别有效。
在社区居住的轻度至中度认知障碍老年人中，ADL依赖的风险很高，但根据一个人执行日常功能简单任务的能力和速度不同而有很大差异。基于身体性能测试的评估策略可能使临床医生能够识别出ADL依赖低风险和高风险的认知受损老年人亚组。
