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系統識別號 U0026-1101201422571500
論文名稱(中文) 住院老人功能衰退、功能軌跡與死亡因素之探討
論文名稱(英文) Functional Decline, Functional Trajectory and Death among Hospitalized Elderly Patients
校院名稱 成功大學
系所名稱(中) 健康照護科學研究所
系所名稱(英) Institute of Allied Health Sciences
學年度 102
學期 1
出版年 103
研究生(中文) 黃惠子
研究生(英文) Hui-Tzu Huang
學號 TA8961063
學位類別 博士
語文別 中文
論文頁數 92頁
口試委員 指導教授-陳清惠
召集委員-林麗嬋
口試委員-林惠賢
口試委員-盧豐華
口試委員-張家銘
中文關鍵字 日常生活活動  老人  功能衰退  功能軌跡  住院  危險因子  存活分析 
英文關鍵字 activity of daily living  elderly  functional decline  functional trajectory  hospitalization  risk factors  survival analysis 
學科別分類
中文摘要 功能衰退為住院老人常見的合併症之一,此導致老人變得依賴,喪失自尊,影響生活形態以及生活品質。本研究旨在探討老人出院後三個月的功能衰退、功能軌跡及出院後死亡因素。在南台灣某醫學中心,採用方便取樣及世代研究設計,以年滿65歲以上之內科住院老人為研究對象。結構性問卷包含人口學變項、老年病症候群、日常生活活動及工具性日常生活活動,迷你智能、老年憂鬱及共病症等量表。功能軌跡主要收集住院前兩週、住院、出院、出院後三個月共四個階段的日常生活活動功能。經排除死亡及連絡不到之個案,研究者共收集273位老人日常生活活動功能資料,結果顯示出院後三個月有83位老人(30.4%)有功能衰退的情形。老人出院後三個月功能衰退的預測因子包括:住院前一年跌倒次數、住院前兩週工具性日常生活活動功能、住院前及住院期間日常生活活動改變、生病後日常生活活動改變及共病症。而生病後日常生活活動改變量為中介變項。功能軌跡顯示住院老人於住院時功能下降,出院後老人有2/3逐漸恢復功能。老人出院後死亡率為12% (37/308),死亡預測因子有身體質量指數、住院前兩週工具性日常生活活動以及共病症。建議臨床醫護人員整合本研究發現以及運用老人週全性評估,於老人住院期間設計適當及個別性介入措施,以預防出院後功能衰退以及死亡。
英文摘要 Functional decline is considered to be one of the major complications among hospitalized elderly. It leads to elderly loss of independence and self-esteem and resulting in decreased lifestyle and quality of life. The aim of this study was to examine predictors of functional decline and delineate the trajectories of functional status 3 months after discharge, and to explore predictors of death after discharge. A cohort study design and convenience sampling were used at a medical center in southern Taiwan. Hospitalized patients aged 65 and over were recruited in this study. Structure questionnaire included demographic information, Geriatric syndrome, Activities of Daily Living (ADL), Instrument Activities of Daily Living (IADL), Mini-Mental State Examination (MMSE), Geriatric depression Scale and Charlson Comorbidity Index. Functional trajectory, by ADL score, was collected at 4 time points: 2 weeks before admission, admission, discharge and 3 months after discharge. After exclusion of deaths and loss of contact, researchers collected a total of 273 older patients’ ADL information. The results showed that eighty-three (30.4%) patients had a functional decline 3 months after discharge. Logistic regression revealed that the number of falls one year before admission, instrumental ADL (IADL) score 2 weeks before admission, ADL score decline between pre-admission and admission, ADL score decline during hospitalization, ADL score decline between pre-admission and discharge, and comorbidities were significant predictors of ADL score decline 3 months after discharge. The ADL score decline between pre-admission and discharge was the mediator of functional decline 3 months after discharge. Functional trajectory as shown by ADL scores indicated that all older patients dropped steeply at admission and that two thirds were gradually restored 3 months after discharge. Total mortality rate was 12% (n = 37/308) after discharge. Predictors of mortality included body mass index, IADL score two weeks before admission, and comorbidities. Clinical nurses can integrate the findings of this study and apply Comprehensive Geriatric Assessment to tailor intervention during hospitalization to prevent older patient’s functional decline and early mortality after discharge.
論文目次 中文摘要…………………………………………………………… I
Abstract…………………………………………………………………………………………………………… III
誌謝………………………………………………………………… V
目錄………………………………………………………………… VII

表目錄…………………………………………………………………IX
圖目錄…………………………………………………………………X

第一章 緒論……………………………………………………… 1
第一節 研究動機及重要性……………………………………… 1
第二節 研究目的………………………………………………… 4
第三節 研究問題………………………………………………… 4
第四節 研究假設………………………………………………… 5
第五節 名詞界定………………………………………………… 6
第二章 文獻查證………………………………………………… 10
第一節 日常生活活動功能評估………………………………… 10
第二節 住院老人功能衰退的危險因子………………………… 12
第三節 住院老人的功能軌跡變化……………………………… 15
第四節 老人出院後死亡的存活分析…………………………… 17
第三章 研究方法………………………………………………… 20
第一節 研究設計及研究過程…………………………………… 21
第二節 研究場所及對象………………………………………… 25
第三節 研究工具………………………………………………… 26
第四節 統計分析………………………………………………… 30
第五節 倫理考量………………………………………………… 32
第四章 研究結果………………………………………………… 33
第一節 住院老人人口學基本屬性……………………………… 35
第二節 老年病症候群…………………………………………… 37
第三節 老人出院後三個月功能衰退及預測因子……………… 39
第四節 住院老人的功能軌跡變化……………………………… 43
第五節 老人出院後的存活分析………………………………… 48
第五章 討論……………………………………………………… 53
第一節 老人出院後功能衰退及預測因子……………………… 54
第二節 老人出院後三個月的功能軌跡變化…………………… 56
第三節 老人出院後的存活分析………………………………… 58
第六章 結論與建議……………………………………………… 59
第一節 結論……………………………………………………… 59
第二節 研究限制………………………………………………… 61
第三節 應用與建議……………………………………………… 63
參考文獻 …………………………………………………………… 66
中文部分 …………………………………………………………… 66
英文部分 …………………………………………………………… 68
附錄一 同意臨床試驗證明書…………………………………… 80
附錄二 住院老人功能衰退調查問卷…………………………… 81


表目錄
表3-1資料收集時間及項目……………………………………………23
表4-1人口學基本屬性…………………………………………………36
表4-2老年病症候群……………………………………………………38
表4-3住院老人出院後三個月功能衰退情形…………………………41
表4-4住院老人出院後三個月功能衰退之預測因子…………………42
表4-5兩組在四個時間點變化上功能(ADL)之差異………………… 46
表4-6在不同時間點兩組功能(ADL)的差異,以T0為共變項…………47
表4-7 老人存活期………………………………………………………50
表4-8 住院老人出院後死亡的存活分析………………………………52

圖目錄
圖1-1 功能軌跡圖示……………………………………………………08
圖3-1研究架構圖…………………………………………………………20
圖3-2研究步驟流程圖……………………………………………………24
圖4-1收案流程圖…………………………………………………………34
圖4-2老人功能軌跡變化…………………………………………………45
圖4-3住院老人出院後死亡的存活函數…………………………………51
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