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系統識別號 U0026-2708201210224800
論文名稱(中文) 以簡易活動介入對高齡住院患者活動功能衰退之成效探討
論文名稱(英文) Effects of simplified activity program on functional decline in hospitalized older patients
校院名稱 成功大學
系所名稱(中) 老年學研究所
系所名稱(英) Institute of Gerontology
學年度 100
學期 2
出版年 101
研究生(中文) 黃儀婷
研究生(英文) Yi-Ting Huang
學號 tc6994056
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-張家銘
口試委員-陳清惠
召集委員-官大紳
中文關鍵字 高齡住院患者  活動功能衰退  簡易活動  活動介入 
英文關鍵字 Hospitalized older patients  functional decline  simplified activity  intervention 
學科別分類
中文摘要 研究背景:行政院衛生署於2011年統計65歲以上的高齡住院人數佔總住院人數的28%,大約30-60%的高齡住院患者在出院後將無法執行原住院前之活動功能程度。若健康照護者能即時掌握高齡住院患者發生功能衰退的潛在因子,早期介入與防範,應能降低失能風險。
研究目的:探討指導簡易活動介入對高齡住院患者降低因住院導致活動功能衰退之成效。
研究方法:採介入性研究,以南部醫學中心內科病房為收案場域,65歲以上高齡住院患者為收案對象,採隨機分派分為對照組、口頭提醒組及活動介入組,分別提供常規照護、口頭提醒受試者活動及實際協助受試者活動。除了一般生理功能測量外,我們利用改良式巴氏量表量測出院前二週、住院時、入院時、出院一個月及三個月的生活活動功能的變化。
研究結果:在步行四公尺速度、起立行走測試、手握力測試、改良版巴式量表及自覺健康滿意度(EQ5D)的量測,於出院時、出院後一個月及出院後三個月評估時,三組均無統計上顯著差異。但在不同時間點的改善比較方面,則在出院後一個月至出院後三個月的步行四公尺速度、出院時至出院後三個月的起立行走測試、出院時至出院後三個月以及出院後一個月至出院後三個月的自覺健康滿意度也都有顯著的改善,且有統計上顯著意義。
研究結論:本研究結果顯示,對於高齡住院患者口頭提醒或實際介入簡易活動,在住院後一至三個月可看到部分生理功能及自覺健康滿意度的改善。未來可進一步分析影響介入成效的因素及介入的成本效益,以提供臨床醫護人員有效之老年照護應用。
英文摘要 Background:In 2011, data from the Department of Health, Executive Yuan in Taiwan reported that patients aged beyond 65 years accounted for 28% among hospitalized patients. In addition, functional activities among 30% to 60% of hospitalized older patients could not return to the baseline levels before admission after they were discharged. If health care professionals understand the risk factors of functional decline among these patients, disability may be reduced by early intervention and prevention.
Objective:To evaluate the effect of the simplified activities on preventing functional decline among hospitalized older patients
Methods:The intervention trial was conducted at medical wards of a medical center in Southern Taiwan. Patients aged more than 65 years were randomly assigned to control group, reminding group and activity group, of which the elderly patients enrolled were provided routine care, reminding for simplified activity or simplified activity with assistance. In addition to physical measurements, the functional activity was evaluated by Modified Barthel Index at two weeks before admission, at admission, on the day of discharge, and at one month and three months after discharge.
Results: On assessment at discharge, a month after discharge and three months after discharge, there was no significantly statistical difference between three groups on the measurements of 4-meter walking speed, timed up and go, hand grip strength, Modified Barthel Index, and self-perceived health status (EQ5D). Sevreal statistically significant improvements were noted after discharge: 4-meter walking speed from 1 month to 3 months after discharge, timed up and go from discharge to 3 months after discharge, and self-perceived health status from discharge to 3 months after discharge and from 1 month to 3 months after discharge.
Conclusion:Our study show simplified activity by reminding or assistance could improve part of physical function and self-perceived health status. Further analysis to clarify the factor of successful intervention and cost-effectiveness is needed for clinical implications on the geriatric care by health care professionals.
論文目次 中文摘要 I
英文摘要 II
致謝 IV
第一章 緒論 1
第一節 研究背景及動機 1
第二節 研究目的 3
第二章 文獻查證 4
第一節 高齡住院患者功能衰退情形與相關因素 4
第二節 活動介入對功能衰退的影響 6
第三節 簡易活動(Simplified activity)與復健(Rehabilitation)之比較 7
第三章 研究方法 9
第一節 名詞定義 9
第二節 研究架構 9
第三節 研究設計 10
第四節 研究場所與對象 12
第五節 介入措施 13
第六節 研究過程 17
第七節 研究工具 18
第八節 研究倫理 21
第九節 統計分析與處理 21
第四章 研究結果 22
第一節 描述性分析 22
第二節 推論性分析 24
第五章 討論 31
第一節 以各時間點間之進步成效作分析 31
第二節 具有顯著差異之指標:自覺健康滿意度 32
第三節 具有顯著差異之指標:步行四公尺時間 32
第四節 無顯著差異之指標中的統計分析趨勢:手握力測試 33
第五節 無顯著差異之指標中的統計分析趨勢:起立行走測試 34
第六節 本研究與其他研究之比較 34
第七節 極端值對標準差和統計分析的影響 35
第八節 研究的困難與限制 36
第六章 結論與建議 38
第一節 結論 38
第二節 應用與建議 39
第三節 未來方向 40
第七章 參考文獻 41
附件 47
附件一 同意臨床試驗證明書 47
附件二 研究同意書 48
附件三 全期評估問卷 50
附件四 每日活動追蹤表 54
附件五 出院日追蹤表 55
附件六 每週電訪追蹤表 57
附件七 出院後第一個月追蹤表 58
附件八 出院後第三個月追蹤表 60
附件九 綜合量表問卷 62
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