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系統識別號 U0026-2308201111420900
論文名稱(中文) 住院老人功能衰退與跌倒關係之探討
論文名稱(英文) Relationship Between Fall and Functional Decline among Hospitalized Elderly Patients
校院名稱 成功大學
系所名稱(中) 護理學系碩博士班
系所名稱(英) Department of Nursing
學年度 99
學期 2
出版年 100
研究生(中文) 江佩紋
研究生(英文) Pei-Wen Chiang
學號 t26984025
學位類別 碩士
語文別 中文
論文頁數 64頁
口試委員 指導教授-陳清惠
口試委員-劉立凡
召集委員-張家銘
中文關鍵字 住院老人  功能衰退  跌倒經驗 
英文關鍵字 hospitalized elderly patients  functional decline  fall history 
學科別分類
中文摘要 過去研究顯示,老年人發生跌倒之危險因子與導致住院老人功能衰退之預測因子有許多重疊,目前針對住院老人,臨床十分重視跌倒危險因子之篩檢與防護,若能同時關注出院後功能衰退之可能,將有利於即早介入,但有關住院老人之跌倒經驗與其出院後功能衰退之關係仍不清楚,故本研究的目的為探討住院老人功能衰退與跌倒經驗之間的關係。
本研究為描述性相關性研究,資料源自「探討住院老人功能衰退的危險因子」的研究計畫。該研究計畫是以立意取樣方式,於南部某醫學中心的8個內科病房,針對65歲以上的住院老年人,且能以國、台語溝通為對象,以隨機取樣方式選擇個案,並進行結構性問卷調查。原計畫的目的為瞭解台灣住院老人功能衰退現況及分析台灣住院老人功能衰退的危險因子。本研究乃擷取原計畫第一次(入院48小時內)的結構性訪談資料及第二(出院時)、三次(出院後3個月)的電話追蹤訪談資料中的凱茲日常生活活動量表(Katz ADL)、工具性日常生活量表(IADL)、迷你智能狀態測驗(MMSE)等問卷資料。運用SPSS for windows 17.0統計軟體進行描述性及推論性統計
分析。
結果顯示,有跌倒經驗之個案,住院時ADL的衰退(OR=23.089, 95% CI=6.062-87.947)與出院時的功能衰退有顯著相關;而出院後三個月的功能衰退,與住院時ADL衰退(OR=3.094, 95% CI=1.335-7.174)及聽力障礙(OR=0.314, 95% CI=0.120-0.819)有顯著相關。對於無跌倒經驗之個案,住院時ADL衰退(OR=18.514, 95% CI=7.005- 48.936)與出院時的功能衰退有顯著相關;而居住狀況(OR=0.209, 95% CI=0.054-0.808)、住院時ADL衰退(OR=2.988, 95% CI=1.275-7.002)、住院前兩個禮拜的IADL(OR=0.817, 95% CI=0.688-0.969)、住院時的CCI(OR=1.320, 95% CI=1.074-1.621),與出院後三個月的功能衰退呈顯著相關。比較有無跌倒經驗兩組個案之功能衰退重要影響因子發現,僅住院時的功能衰退程度會影響無論有無跌倒經驗者,出院時及出院後三個月功能的恢復。此研究結果可提供臨床醫療人員參考,於病人入院初期,在篩選病人是否為跌倒之高危險群的同時,並關注功能衰退之相關危險因子,以即早介入,維護住院老人獨立生活之功能。
英文摘要 Previous studies indicated that parts of the risk factors of falls in elders were same as the predictors of function decline among hospitalized elders. Currently, fall prevention is essential among hospitalized elders, and almost every elderly patient may require assessing the risks of fall at admission. If we can assess the risks of functional decline at the same time, early prevention for functional decline among elderly patients can be intervened. However, the relationship between fall history and functional decline among hospitalized elders was not clear. Therefore, the purpose of this study was to examine the association between fall history in previous year and functional decline among hospitalized elderly.
This research was a cross-sectional and correlation study. The data originated from the research project entitled “Risk Factors of Functional Decline in Hospitalized Elderly Patients.” Subjects were recruited through purposive sampling from 8 internal medicine wards in a medical center in southern Taiwan. Inclusion criteria included age 65 or above and being able to communicate in Mandarin or Taiwanese. A structured questionnaire was used to collect data on admission, discharged, and 3 months after discharge. The purpose of the original project was to study the risk factors of functional decline among hospitalized elderly. Data regarding subjects’ demographic information, Katz ADL (Activity of Daily Living), IADL (Instrument Activity of Daily Living) and associated information were retrieved. Descriptive and inferential statistics were applied to analyze data using SPSS for Windows 17.0 statistical software.
The results showed that those hospitalized elderly patients with fall history their ADL scores declined on admission (OR=23.089, 95% CI=6.062-87.947) was significantly associated with functional decline at discharged, while ADL decline on admission (OR=3.094, 95% CI=1.335-7.174) and hearing impairment (OR=0.314, 95% CI=0.120-0.819) were significant predictors of functional decline 3 months after discharged. For those hospitalized elderly patients without fall history in previous year their ADL scores declined on admission (OR=18.514, 95% CI=7.005- 48.936) was also significantly associated with functional decline at discharged, while living conditions (OR=0.209, 95% CI=0.054-0.8089), ADL declined on admission (OR=2.988, 95% CI=1.275-7.002), two weeks before admission IADL (OR=0.817, 95% CI=0.688-0.969), and admission CCI (OR=1.320, 95% CI=1.074-1.621) were significant associated with functional decline at 3 months after discharge. Compared between group with fall and no fall history, only ADL declined on admission was the significant factor associated with functional decline at discharged and 3 months after discharged in both groups. The findings of this study remind health care professionals, when screening fall history; they should also pay attention to those patients who are high risk in functional decline. Early interventions are needed to maintain the functional independence of hospitalized elderly
patients.
論文目次 摘要.......................................................I
致謝......................................................VI
目錄.....................................................VII
表目錄....................................................IX
圖目錄....................................................IX
附件目錄...................................................X
第一章 緒論.................................................1
第一節 背景與重要性..........................................1
第二節 研究目的.............................................3
第二章 文獻查證.............................................4
第一節 住院老人身體功能衰退的危險因子..........................4
第二節 老人跌倒的危險因子.....................................7
第三節 老人跌倒與功能衰退....................................10
第三章 研究問題與研究架構....................................12
第一節 名詞解釋............................................12
第二節 研究架構............................................13
第三節 研究問題............................................14
第四章 研究方法............................................15
第一節 研究設計............................................15
第二節 資料來源及內容.......................................15
第三節 研究對象............................................16
第四節 研究過程............................................16
第五節 研究工具............................................16
第六節 研究倫理考量.........................................19
第七節 資料處理與分析.......................................20
第五章 研究結果............................................23
第一節 研究對象人口學屬性及健康狀況...........................23
第二節 有跌倒經驗的住院老人功能衰退的相關因子..................30
第三節 無跌倒經驗的住院老人功能衰退的相關因子..................36
第六章 討論................................................44
第一節 有跌倒經驗之住院老人的人口學及健康狀況之特性.............44
第二節 有跌倒經驗的住院老人功能衰退之重要相關因子...............44
第三節 無跌倒經驗的住院老人其功能衰退之重要相關因子.............45
第四節 有無跌倒經驗的住院老人其功能衰退之比較..................47
第七章 結論與建議...........................................48
第一節 結論................................................48
第二節 研究結果的應用及建議..................................49
第三節 研究限制與未來研究建議................................50
參考文獻...................................................51
中文部份.................................................51
英文部分................................................53
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