通所介護サービスを利用する要介護高齢者のADL低下に関連する運動機能

• Published in: 理学療法学 Vol. 40; no. 6; pp. 407 - 413
• Main Authors: 林 悠太, 鈴川 芽久美, 波戸 真之介, 石本 麻友子, 金谷 勇歩, 島田 裕之
• Format: Journal Article
• Language: Japanese
• Published: 日本理学療法士学会 2013; Japanese Society of Physical Therapy
• Subjects: FIM-M; カットオフ値; 歩行速度
• ISSN: 0289-3770; 2189-602X
• DOI: 10.15063/rigaku.kj00008954024

Purpose: The purpose of this study was to examine the relationship between physical performance and a decline in activities of daily living (ADL) in elderly people who were certified by Japanese long-term care insurance. Methods: The subjects were 2,695 elderly people who used day-care services (mean age: 81.9 ± 6.7 years; men: 916; women: 1,779). The 13 motor subscales of the Functional Independence Measure were used to assess ADL. The subjects were divided into two groups: the ADL independent group, who scored ≥ 6 points in all ADL measures, and the ADL care need group, who scored ≤ 5 points for at least one item in all ADL measures. Physical performance tests included grip strength, the chair stand test 5 times, one leg standing with the eyes open, walking speed, and the timed "up & go" test. The multiple logistic regression analysis was used to identify the relationships between ADL status and physical performances which were showed significant differences in univariate analysis. Results: The multiple logistic regression model showed that all physical performances were significantly associated with a decline in ADL. By the analysis for the level of care, the moderately disabled group, performance in grip strength, the chair stand test 5 times, walking speed and the timed "up & go" test were significantly associated with a decline in ADL. In the severely disabled group, walking speed was significantly associated with a decline in ADL. Walking speed showed a particularly strong correlation with a decline in ADL (moderately disabled: OR, 2.56; 95% CI, 1.57-4.16; p<0.01; severely disabled: OR, 2.36, 95% CI, 1.12-5.50; p<0.05). Conclusions: Our results suggest that targeted intervention to improve walking speed may be useful for preventing a decline in ADL in elderly people. 【目的】本研究の目的は,通所介護サービスを利用する要介護認定を受けた高齢者(以下,要介護高齢者)を対象に,日常生活活動(activities of dally llving:以下,ADL)の低下因子を,運動機能の側面から検討することである。【方法】対象は通所介護サービスを利用する要介護高齢者2,695名(平均年齢81.9±6.7歳,男性916名,女性1,779名)とした。ADLの評価はFunctional independence measureの運動項目13項目を用い,すべての項目が6点以上である者を自立群,1項目でも5点以下の項目がある者を介助群として対象者を2群に分類した。運動機能は,握力,chair stand test 5-times (CST-5),開眼片足立ち,歩行速度,timed "up & go" testの5項目を測定した。自立群と介助群間における運動機能の比較を行い,有意差が認められた項目を独立変数,自立の有無を従属変数として多重ロジスティック回帰分析を行った。【結果】多重ロジスティック回帰分析の結果,単変量解析で有意差が認められた5項目の運動機能すべてにおいて,ADLと有意な関連が認められた。要介護度の重症度別(軽度群,重度群)で検討したところ,軽度群では握力,CST-5,歩行速度,TUGと有意な関連があり,重度群でも歩行速度と有意な関連があった。要介護高齢者では歩行速度が強くADLと関連していた(軽度群:オッズ比2.56, 95%信頼区間1.57-4.16, P<0.01/重度群:オッズ比2.36, 95%信頼区間1.12-5.50, P<0.05)。【結語】要介護高齢者において,歩行速度がADLと強い関連を示しており,ADL低下予防のための介入を検討する際に,重要視すべき機能であることが示唆された。