Contributions of Environment, Comorbidity, and Stage of Dementia to the Onset of Walking and Eating Disability in Long-Term Care Residents

Objectives To estimate the relative effects of environment, comorbidities, stage of dementia and other variables on disability onset. Design A 1-year prospective cohort study was conducted in which the walking and eating abilities of long-term care residents were observed fortnightly. Structural equation modeling was used to assess the contributions of individual and environmental factors to the onset of disability. Setting Fifteen nursing homes in western Canada. Participants One hundred twenty residents with middle-stage Alzheimer disease or related dementia. Measurements Environmental quality was assessed using the Professional Environmental Assessment Protocol, comorbidity using the Charlson Comorbidity Index, and stage of dementia using the Global Deterioration Scale. Results More-advanced baseline dementia had a direct effect on onset of walking and eating disability (standardized maximum likelihood estimate (SMLE)similar to=similar to 0.24, P similar to=similar to.006). Resident environment (SMLE similar to=similar to-0.25, P similar to=similar to.007) and comorbidities (SMLE similar to=similar to 0.32, P similar to