Sloane P D, Mitchell C M, Preisser J S, Phillips C, Commander C, Burker E
Department of Family Medicine, University of North Carolina at Chapel Hill, 27599, USA.
J Am Geriatr Soc. 1998 Jul;46(7):862-9. doi: 10.1111/j.1532-5415.1998.tb02720.x.
To determine the point prevalence of agitated behaviors in a representative sample of Alzheimer's disease Special Care Units, and to determine the extent to which agitation is associated with aspects of the treatment environment.
A cross-sectional study in which nonparticipant observers recorded 3723 observations of resident behaviors in 53 Alzheimer's disease Special Care Units. Observational data were gathered on the physical environment and staff treatment in these settings, and resident characteristics were extracted from a data base developed in the study states by the Health Care Financing Agency. Analyses studied the association between aspects of the staff and physical environment and resident agitation levels, controlling for resident cognitive and functional status.
Special Care Units in nursing homes in Kansas, Maine, Mississippi, and South Dakota.
All residents and staff of the participating units.
Eight specific agitated behaviors and two indexes of resident agitation were measured by direct observation by research assistants on three to four data collection walk-throughs in each of the study facilities.
The most common agitated behaviors noted were repetitive mannerisms (4.5% of resident observations) and non-loud verbal excess (3.8%). Wandering, which frequently reflects agitation, was noted in 6.5% of resident observations. The proportion of residents exhibiting an agitated behavior varied from none in some units to 38% in one unit. Independent correlates of low unit agitation levels included favorable scores on measures of the physical environment and of staff treatment activities, low rates of physical restraint use, a high proportion of residents in bed during the day, small unit size, low levels of resident functional dependency, and fewer numbers of comorbid conditions.
While the prevalence of agitation tends to increase as Alzheimer's disease progresses, modifiable treatment factors appear to have a strong influence on the prevalence of agitation. Both physical design and staff treatment appear to influence agitation rates, as do some measures consistent with a low stimulus approach to Alzheimer's care.
确定阿尔茨海默病特殊护理单元代表性样本中激越行为的时点患病率，并确定激越与治疗环境各方面的关联程度。
一项横断面研究，非参与观察人员记录了53个阿尔茨海默病特殊护理单元中3723次居民行为观察情况。收集了这些场所物理环境和工作人员治疗方面的观察数据，并从医疗保健筹资机构在研究州建立的数据库中提取居民特征。分析研究了工作人员和物理环境各方面与居民激越水平之间的关联，并对居民认知和功能状态进行了控制。
堪萨斯州、缅因州、密西西比州和南达科他州养老院中的特殊护理单元。
参与单元的所有居民和工作人员。
研究助理在每个研究设施进行三到四次数据收集巡查时，通过直接观察测量了八种特定激越行为和两个居民激越指数。
观察到的最常见激越行为是重复习性（占居民观察次数的4.5%）和非大声言语过多（3.8%）。常反映激越的徘徊行为在6.5%的居民观察中被记录到。表现出激越行为的居民比例在一些单元中为零，在一个单元中高达38%。单元激越水平低的独立相关因素包括物理环境和工作人员治疗活动指标得分良好、身体约束使用率低、白天卧床居民比例高、单元规模小、居民功能依赖程度低以及共病情况较少。
虽然激越患病率往往随着阿尔茨海默病进展而增加，但可改变的治疗因素似乎对激越患病率有很大影响。物理设计和工作人员治疗似乎都影响激越发生率，一些与阿尔茨海默病护理低刺激方法一致的措施也是如此。
