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系統識別號 U0026-1908201813322600
論文名稱(中文) 重症老人疾病前後老年綜合徵候的歷程變化
論文名稱(英文) Trajectory of Geriatric Syndromes Changes Among Elderly Patients Receiving Intensive Care
校院名稱 成功大學
系所名稱(中) 護理學系
系所名稱(英) Department of Nursing
學年度 106
學期 2
出版年 107
研究生(中文) 唐心如
研究生(英文) Hsin-Ju Tang
學號 TA8981063
學位類別 博士
語文別 中文
論文頁數 60頁
口試委員 共同指導教授-張家銘
口試委員-林惠賢
口試委員-陳幸眉
召集委員-蔡仁貞
指導教授-陳清惠
中文關鍵字 重症  老人  老年綜合徵候  生活功能 
英文關鍵字 Intensive care  older adults  geriatric syndromes  functional decline 
學科別分類
中文摘要 背景: 五成以上老年重症存活者,出院後有中等至嚴重程度的功能衰退。而老年綜合徵候是老人功能喪失的關鍵因素。但老年綜合徵候的變化及對臨床結果和生活功能的影響,在老年重症領域尚未被探討。
目的: 本研究目的為1)描述重症老人住院前、轉出加護病房、出院、出院後一、三及六個月共六個測量時間,六項常見老年綜合徵候的變化,2)了解人口學、健康相關變項及住院前六項老年綜合徵候與住院期間死亡的相關性及預測,3)了解六個測量時間老年綜合徵候與臨床結果的相關性,4)探索人口學、健康相關變項及六項老年綜合徵候與六個測量時間重症老人生活功能變化的相關及預測力。
方法: 為前瞻世代性研究,於南部一間醫學中心的內科加護病房進行。研究對象需符合1)年齡≧65歲,2)自己能夠或有同住的主要照顧者可提供研究所需訊息者。收集人口學、健康相關變項及六個測量時間臨床結果、老年綜合徵候及生活功能的資料。
結果: 共192位重症老人同意參與並納入分析。尿失禁、行走障礙和便失禁是六個測量時間點,最多依賴的老年綜合徵候項目。住院期間新增的老年綜合徵候高於可回復的徵候,且存活者有中至嚴重的生活功能依賴。入院前居住於機構、加護病房期間使用呼吸器、五項老年綜合徵候:壓瘡、譫妄、尿失禁、便失禁及行走障礙為生活功能下降的預測因素。BMI體重過重是生活功能上升的預測因子。
結論: 老年綜合徵候和生活功能衰退與老人生活品質密切相關。重症領域對老年綜合徵候與生活功能的評估和照護指引,需儘速建立,以提高照護品質。
英文摘要 SUMMARY
Patients 65 years or older account for more than half of the Intensive Care Unit (ICU) admissions. Approximately 35%-50% of older adults were discharged directly from the ICU to long-term care facilities due to the functioning loss of daily activities. Geriatric syndrome is a major contributing factor for functioning loss in older adults, however, its pattern and trajectory among ICU older adult patients have not been fully understood. This dissertation attempts to describe the patterns of six common geriatric syndromes from admission to post-discharge 6 months in elderly patients receiving intensive care, and the correlation and predictors between geriatric syndromes and the longitudinal functional status changes. With a prospective cohort study design, access to meaningful and valuable results, include:1) Urinary incontinence, impaired mobility, and defection incontinence were the most prevalent geriatric syndrome, 2)The rates of new-onset geriatric syndrome was higher than the resolved rate during the hospitalization, 3) the functional status did not return to the baseline during the follow up, 4) institutionalized prior to hospitalization, use of mechanical ventilation during the ICU stay, pressure sore, existing delirium, urinary incontinence, defection incontinence and impaired mobility were associated with reductions in functional status over 6 months, and overweight was the only factor that was associated with increased functional level. Those important results remind to pay attention to the high prevalence of geriatric syndromes, and the impact on clinical outcomes in older ICU survivors. In order to provide high quality and comprehensive care, to establish the assessment and plan guidelines for geriatric syndromes and introducing the concept of geriatric syndrome into intensive clinical care were pressing and necessary task.
Key Word: Intensive care, older adults, geriatric syndromes, functional decline, Katz's functional index
INTRODUCTION
Nearly 50% of the older Intensive Care Unit (ICU) survivors discharged from the hospital with moderate to severe functional decline. Geriatric Syndromes considered a major contributing factor for functional loss in older adults. However, the pattern of geriatric syndromes and that influence for medical outcomes and functional status changes in older ICU survivors are to be further explored. The purpose of this study was 1) to describe the patterns of six common geriatric syndromes from admission, leave the ICU, discharge and 1, 3 to 6 months post-discharge, and 2) to understand the influence of demographic data, health-related data and geriatric syndromes for the clinical outcome in hospitalization, 3)to assess the correlation between six time points of geriatric syndromes and clinical outcome, and 4)to explore the predictors of the longitudinal functional status changes in older ICU survivors.

MATERIALS AND METHODS
This is a prospective cohort study. Convenience sampling was used to recruit participants from two medical ICUs at a medical center in urban southern Taiwan. Inclusion criteria were 1) age ≥ 65 years old, and 2) able to or have a primary caregiver to provide consent and assessment information throughout the study. Demographic information, health-related data, and six times measurements (the past two weeks period prior to ICU admission, the day of leaving ICU, the hospital discharging day, and 1, 3 and 6 months post-discharge) of the clinical outcome, geriatric syndromes, and functional status were collected.

RESULTS AND DISCUSSION
A total of 192 medical ICU older adult survivors were included in the analysis. Urinary incontinence, impaired mobility, and defection incontinence were the most prevalent syndrome at 6-times points. The rate of new-onset geriatric syndrome was higher than the resolved rate during the hospitalization, and the survivors have medium to severe functional dependency post-discharge, the functional status did not return to the baseline, even at the 6-month. Factors associated with reductions in functional status over 6 months were: 1) institutionalized prior to hospitalization, 2) use of mechanical ventilation during the ICU stay, and 3) five common geriatric syndromes, included pressure sore, existing delirium, urinary incontinence, defection incontinence and impaired mobility. Importantly, overweight was the only factor that was associated with increased functional level over 6 months.
CONCLUSION
Geriatric syndromes and functional decline are significantly related to the quality of life of the elderly. In order to provide high quality and comprehensive care, the clinical guidelines of geriatric syndromes assessment and plan in older ICU survivors need to be created immediately.
論文目次 目錄
中文摘要 I
ABSTRACT II
誌謝 V
目錄 i
表目錄 iii
圖目錄 iii
第一章 緒論 1
第一節 研究背景及重要性 1
第二節 研究目的 3
第二章 文獻查證 4
第一節 老年綜合徵候定義 4
第二節 老年綜合徵候盛行率 5
第三節 老年綜合徵候相關因素及對治療成果預測 6
第四節 老年綜合徵候與生活功能的交互影響 7
第三章 研究方法 9
第一節 研究設計、場所及對象 9
第二節 研究過程 9
第三節 研究架構 12
第四節 研究工具 13
第五節 統計分析 17
第六節 倫理考量 17
第四章 研究結果 18
第一節 人口學及健康相關資料 19
第二節 臨床成果 21
第三節 老年綜合徵候盛行率及住院前後的變化 22
第四節 老年綜合徵候與臨床成果的相關 25
第五節 生活功能及其子項目住院前後的變化 26
第六節 各變項與六個測量時間生活功能變化的相關性 29
第五章 討論 31
第一節 人口學、健康相關資料及臨床成果 31
第二節 老年綜合徵候住院前後的變化 32
第三節 老年綜合徵候與臨床成果的相關性 33
第四節 重症老人功能變化與各變項的相關性 34
第六章 結論 37
第一節 結論與建議 37
第二節 研究限制 37
參考文獻 39
附錄一 同意臨床試驗證明書 52
附錄二 研究同意書 53
附錄三 研究問卷 56
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