■步行对于在老年住宅护理(ARC)中保持身心健康很重要。由于评估方法和指标的不一致以及有关护理环境影响的研究有限,因此在ARC中行走行为的特征不佳。认知,或这些行为的身体功能。建议使用经过验证的数字方法评估ARC中的行走行为,该方法可以捕获少量的行走活动。
■这项研究旨在表征和比较ARC居民在不同护理水平下的加速度测量得出的行走行为,认知能力,和物理能力。
■从StayingUpRight随机对照试验中招募了306名ARC居民,来自3个护理级别:疗养院(n=164),医院(n=117),和痴呆症护理(n=25)。参与者的认知状态被归类为轻度(n=87),中等(n=128),或严重损害(n=61);使用蒙特利尔认知评估和短物理性能电池截止分数将身体功能分为高-中度(n=74)和低-非常低(n=222)。分别。为了评估行走,参与者在下背部佩戴加速度计(AxivityAX3;尺寸:23×32.5×7.6mm;体重:11g;采样率:100Hz;量程:±8g;记忆:512MB),持续7天.成果包括卷(即,每天走路的时间,steps,andbouts),模式(即,平均步行回合持续时间和阿尔法),和步行的可变性(大约长度)。协方差分析用于评估按护理水平分类的组间行走行为的差异,认知,或身体功能,同时控制年龄和性别。使用用于多重比较的Tukey诚实显着差异测试来确定发生显着差异的位置。使用Hedgesg(0.2-0.4:小,0.5-0.7:中等,和0.8:大)。
■痴呆症护理居民表现出更大的步行量(P<.001;对冲g=1.0-2.0),较长(P<.001;对冲g=0.7-0.8),与其他具有较低alpha评分的护理水平相比,差异更大(P=.008;P<.001与医院比较;对冲g=0.6-0.9)(vs医院:P<.001;对冲g=0.9,vs疗养院:P=.004;对冲g=0.8)。患有严重认知障碍的居民需要更长的时间(P<.001;对冲g=0.5-0.6),更多变量(P<.001;对冲g=0.4-0.6)与轻度和中度认知障碍患者相比。身体功能低-非常低的居民的步行量较低(每天的总步行时间和回合:P<.001;每天的步数:P=.005;对冲g=0.4-0.5)和更高的变异性(P=.04;对冲g=0.2)。
■ARC不同护理水平的居民,认知,和身体功能表现出不同的行走行为。然而,ARC居民经常表现出不同水平的认知和身体能力,反映了它们复杂的多重性质,这应该在进一步的工作中加以考虑。这项工作表明了考虑与数量有关的数字成果的细微差别框架的重要性,模式,ARC居民步行行为的变异性。
UNASSIGNED: Walking is important for maintaining physical and mental well-being in aged residential care (ARC). Walking behaviors are not well characterized in ARC due to inconsistencies in assessment methods and metrics as well as limited research regarding the impact of care environment, cognition, or physical function on these behaviors. It is recommended that walking behaviors in ARC are assessed using validated digital methods that can capture low volumes of walking activity.
UNASSIGNED: This study aims to characterize and compare accelerometry-derived walking behaviors in ARC residents across different care levels, cognitive abilities, and physical capacities.
UNASSIGNED: A total of 306 ARC residents were recruited from the Staying UpRight randomized controlled trial from 3 care levels: rest home (n=164), hospital (n=117), and dementia care (n=25). Participants\' cognitive status was classified as mild (n=87), moderate (n=128), or severe impairment (n=61); physical function was classified as high-moderate (n=74) and low-very low (n=222) using the Montreal Cognitive Assessment and the Short Physical Performance Battery cutoff scores, respectively. To assess walking, participants wore an accelerometer (Axivity AX3; dimensions: 23×32.5×7.6 mm; weight: 11 g; sampling rate: 100 Hz; range: ±8 g; and memory: 512 MB) on their lower back for 7 days. Outcomes included volume (ie, daily time spent walking, steps, and bouts), pattern (ie, mean walking bout duration and alpha), and variability (of bout length) of walking. Analysis of covariance was used to assess differences in walking behaviors between groups categorized by level of care, cognition, or physical function while controlling for age and sex. Tukey honest significant difference tests for multiple comparisons were used to determine where significant differences occurred. The effect sizes of group differences were calculated using Hedges g (0.2-0.4: small, 0.5-0.7: medium, and 0.8: large).
UNASSIGNED: Dementia care residents showed greater volumes of walking (P<.001; Hedges g=1.0-2.0), with longer (P<.001; Hedges g=0.7-0.8), more variable (P=.008 vs hospital; P<.001 vs rest home; Hedges g=0.6-0.9) bouts compared to other care levels with a lower alpha score (vs hospital: P<.001; Hedges g=0.9, vs rest home: P=.004; Hedges g=0.8). Residents with severe cognitive impairment took longer (P<.001; Hedges g=0.5-0.6), more variable (P<.001; Hedges g=0.4-0.6) bouts, compared to those with mild and moderate cognitive impairment. Residents with low-very low physical function had lower walking volumes (total walk time and bouts per day: P<.001; steps per day: P=.005; Hedges g=0.4-0.5) and higher variability (P=.04; Hedges g=0.2) compared to those with high-moderate capacity.
UNASSIGNED: ARC residents across different levels of care, cognition, and physical function demonstrate different walking behaviors. However, ARC residents often present with varying levels of both cognitive and physical abilities, reflecting their complex multimorbid nature, which should be considered in further work. This work has demonstrated the importance of considering a nuanced framework of digital outcomes relating to volume, pattern, and variability of walking behaviors among ARC residents.