Teresi J A, Holmes D, Koren M J, Dichter E, Ramirez M, Fairchild S
HHAR, Research Division, Riverdale, NY 10471, USA.
Soc Psychiatry Psychiatr Epidemiol. 1998 Jun;33(6):283-90. doi: 10.1007/s001270050056.
Despite an increasing emphasis on adult day health care (ADHC) programs as alternatives to institutional care for persons with dementia, little research based on direct assessment of clients' cognitive status has been conducted in such settings. The goal of this analysis was to estimate the prevalence of cognitive impairment among ADHC clients using commonly used screening measures. Age-adjusted and non-age-adjusted prevalence estimates of cognitive impairment in New York State ADHC programs were developed using a probability sample of 336 clients. Estimates were made using traditional cutting scores on standard cognitive screening measures, such as the Mini-Mental State Examination (MMSE), as well as latent class analyses applied to the same item sets. Average prevalence estimates of cognitive impairment were 55% across age cohorts and 60% for persons aged 65 and over. The MMSE yielded a prevalence estimate of 58% across age cohorts and 63% for those aged 65 and over. Using a more conservative cut score, the estimate for the MMSE was 33%; latent class estimates of moderate to severe impairment indicate that approximately 30% of the ADHC clients had cognitive impairment suggestive of probable or definite dementia. Community alternatives to institutional care for the elderly are increasing in popularity. These findings suggest that 1. While institutions are serving the most severely cognitively impaired, age-adjusted prevalence ratios for the ADHC sample approach the bounds of the institutional estimates. 2. The institutional setting will continue to be an important mode of care for the more severely impaired individuals. 3. Daycare is serving a high proportion of the mildly and moderately cognitively impaired individuals. It follows, therefore, that such programs need to address the needs of these individuals by developing specialized care plans and tracks targeted for the cognitively impaired.
尽管越来越强调成人日托保健（ADHC）项目可作为痴呆症患者机构护理的替代方案，但在这类环境中，基于对客户认知状况直接评估的研究却很少。本分析的目的是使用常用筛查方法估算ADHC客户中认知障碍的患病率。利用336名客户的概率样本，得出了纽约州ADHC项目中认知障碍的年龄调整患病率和非年龄调整患病率估计值。估计值是使用标准认知筛查措施（如简易精神状态检查表（MMSE））的传统临界分数以及应用于相同项目集的潜在类别分析得出的。各年龄组认知障碍的平均患病率估计为55%，65岁及以上人群为60%。MMSE得出的各年龄组患病率估计为58%，65岁及以上人群为63%。使用更保守的临界分数，MMSE的估计值为33%；中度至重度障碍的潜在类别估计表明，约30%的ADHC客户存在提示可能或确诊痴呆症的认知障碍。针对老年人的机构护理的社区替代方案越来越受欢迎。这些发现表明：1. 虽然机构护理服务的是认知障碍最严重的患者，但ADHC样本的年龄调整患病率接近机构估计范围。2. 机构环境将继续是为更严重受损个体提供护理的重要模式。3. 日托服务了很大比例的轻度和中度认知障碍个体。因此，这类项目需要通过制定专门针对认知障碍患者的护理计划和路径来满足这些个体的需求。
