Environmental correlates to behavioral health outcomes in Alzheimer's special care units.
Environmental correlates to behavioral health outcomes in Alzheimer's special care units.
复制标题
环境与阿尔茨海默病特殊护理病房的行为健康结果相关。
DOI：
10.1093/geront/43.5.697
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发表时间：
2003
期刊：
影响因子：
--
通讯作者：
Holmes,William
中科院分区：
文献类型：
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作者：
Zeisel,John;Silverstein,NinaM;Hyde,Joan;Levkoff,Sue;Lawton,MPowell;Holmes,William
目的：我们系统地测量了养老院特殊护理单元的环境设计特征与居住在那里的阿尔茨海默病或相关障碍患者中攻击性、激越、社交退缩、抑郁和精神问题的发生率之间的关系。设计和方法：我们开发并测试了一个针对阿尔茨海默病患者的环境中与健康相关的关键环境设计特征的模型。我们使用分层线性建模统计技术评估了15个特殊护理病房的427名居民的七个环境设计特征与行为健康指标之间的关联。行为健康测量包括Cohen-Mansfield躯体激动量表、言语激动量表和攻击行为量表，老年受试者抑郁和社交退缩多维度观察量表，以及Behavior-AD(精神病症症状量表)误认和偏执妄想量表。统计控制包括认知状况、日常生活活动的援助需要、处方药使用、阿尔茨海默氏症工作人员培训量和工作人员与居民比率等的影响。尽管分层线性建模将II型错误的风险降到了最低，但这项探索性研究也特别注意避免I型错误-未能认识到行为健康特征和自变量之间可能的关系。结果：我们发现每个行为健康指标与特定的环境设计特征之间，以及行为健康指标与居民和非环境设施变量之间的关联。意义：本研究证明了环境有助于改善阿尔茨海默氏症症状的潜力。在改善阿尔茨海默病患者的健康、行为和生活质量方面，药物、行为和环境方法的平衡组合可能是最有效的。
Purpose:We systematically measured the associations between environmental design features of nursing home special care units and the incidence of aggression, agitation, social withdrawal, depression, and psychotic problems among persons living there who have Alzheimer's disease or a related disorder.Design and Methods:We developed and tested a model of critical health-related environmental design features in settings for people with Alzheimer's disease. We used hierarchical linear modeling statistical techniques to assess associations between seven environmental design features and behavioral health measures for 427 residents in 15 special care units. Behavioral health measures included the Cohen-Mansfield physical agitation, verbal agitation, and aggressive behavior scales, the Multidimensional Observation Scale for Elderly Subjects depression and social withdrawal scales, and BEHAVE-AD (psychotic symptom list) misidentification and paranoid delusions scales. Statistical controls were included for the influence of, among others, cognitive status, need for assistance with activities of daily living, prescription drug use, amount of Alzheimer's staff training, and staff-to-resident ratio. Although hierarchical linear modeling minimizes the risk of Type II—false positive—error, this exploratory study also pays special attention to avoiding Type I error—the failure to recognize possible relationships between behavioral health characteristics and independent variables.Results:We found associations between each behavioral health measure and particular environmental design features, as well as between behavioral health measures and both resident and nonenvironmental facility variables.Implications:This research demonstrates the potential that environment has for contributing to the improvement of Alzheimer's symptoms. A balanced combination of pharmacologic, behavioral, and environmental approaches is likely to be most effective in improving the health, behavior, and quality of life of people with Alzheimer's disease.