髖關節骨折患者入住中期照護之成效探討

The Effectiveness of Intermediate Care for Hip-fracture Patients

羅大維(Ta-Wei Luo) ； 郭亮君(Liang-Chun Kuo) ； 唐憶淨(Yih-Jing Tang)

《台灣老年醫學暨老年學雜誌》 7卷1期 (2012/03) Pp. 20-36

https://doi.org/10.29461/TGG.201203.0002

摘要

目的：比較髖關節骨折患者入住中期照護其入院時及出院時之日常生活功能（ADL, activity of daily living）、工具性日常生活功能（IADL, instrumental activity of daily living）、老人憂鬱量表（GDS, geriatric depression scale）之差異及探討影響髖關節骨折病患出院時其日常生活功能獨立的相關因素。方法：採前瞻性介入性世代研究（prospective intervention cohort study），研究樣本取自台灣北、中、南部共五所榮民醫院之髖關節骨折病患，針對完成急性治療療程，經老年醫學專科醫師評估後轉入中期照護單位，評估其入住中期照護時與出院時的日常生活功能、工具性日常生活功能、老人憂鬱量表的差異變化，並探討影響病患出院時日常生活功能獨立的相關因素。本研究以SAS 9.1版套裝統計軟體，依研究目的及研究假設變項屬性進行統計分析。結果：共有124位個案參與本研究，研究個案中以男性居多116位（93.6%），平均年齡為82.1歲，53.2%為單身，教育程度國小以下佔68.9%，平均住院天數44天。整體而言，入住中期照護接受多專業醫療團隊的照護服務後，其ADL、IADL及GDS皆有顯著的改變且達統計上顯著差異（p＜0.0001）。進一步以ADL≧70為日常生活功能獨立指標，發現教育程度、入院時IADL與出院時ADL獨立性有顯著相關，以多變項邏輯斯迴歸（Multivariate Logistic Regression）分析，結果顯示入院時IADL狀態預測出院時ADL的獨立性強度最強（OR=0.696，95%CI=0.546~0.888），故入院時IADL狀態與出院時ADL獨立性顯著相關。結論：髖關節骨折病患入住中期照護後，ADL、IADL、GDS均有顯著的復健成效。其中入院時IADL的評估，可視為病患出院前日常生活功能能否獨立的評估指標。

關鍵字

髖關節骨折 ； 老人 ； 中期照護 ； 日常生活功能

並列摘要

Objective: To compare the differences in activities of daily living (ADL), instrumental activities of daily living (IADL), and geriatric depression scale (GDS) before and after intermediate care and to discuss the potential factors affecting the ADL of hip fracture patients after hospitalization.Methods: This is a prospective intervention cohort study with samples of hip fracture patients from five veterans' hospitals in northern, central, and southern Taiwan. This study evaluated the changes in ADL, IADL, and GDS of hip fracture patients before they were transferred to and after they were released from intermediate care hospitals, after receiving emergency treatment and assessment by geriatricians. The study further discussed the potential factors affecting the ADL of patients after hospitalization. Data were analyzed with SAS 9.1 packaged software for statistical analysis according to the research purposes, assumptions and variable attributes.Results: A total of 124 samples participated in this study. Most of them were male (116, 93.6%), at an average age of 82.1, single (53.2%) and reported an educational level below elementary school (68.9%) and an average hospitalization time of 44 days. After receiving care from professional medical teams at intermediate care hospitals, the participants reported significant improvement in their ADL, IADL and GDS that reached a statistical difference (p＜0.0001). Using ADL≧70 as the ADL benchmark, the study found educational level and the IADL before admission significantly correlated to independence in ADL after hospitalization. Results of multivariate logistic regression analysis identified the IADL status at admission as the best indicator of the independence in ADL after hospitalization (OR=0.696, 95% CI=0.546~0.888). Thus, the IADL status at admission is significantly related to the independence in ADL after hospitalization.Conclusions: After receiving intermediate care, elderly hip-fracture patients showed significant improvement in their ADL, IADL and GDS. The IADL evaluation during admission can be used as an indicator of the independence in ADL before discharging from intermediate care.

並列關鍵字

hip fracture ； elderly ； intermediate care ； ADL