每日探訪及認知刺激活動對住院老年病患認知功能之影響

The Effect of Daily Visit and Cognitive Stimulation Activities on Cognitive Function of Hospitalized Elderly

鄭嘉旻(Chia-Min Cheng)

指導教授 ： 陳佳慧

國立臺灣大學/醫學院/護理學研究所/碩士(2009年)

https://doi.org/10.6342/NTU.2009.10422

摘要

認知功能改變是老年病患住院期間常見的合併症，會直接影響病患之日常生活功能，使其失去獨立性，進而導致住院日數延長，再入院、入住機構機會及死亡率增加。國外在多年前就已開始注重這個問題，並已發展出一套完整的住院老人照護介入計畫，成功降低住院期間認知功能下降的發生率。近年來，國內也開始重視與老人住院期間照護相關的議題，但針對預防住院期間認知功能改變的實證研究仍缺乏，故本研究參考國外相關文獻，自擬成「每日探訪及認知刺激活動方案」並進行實證研究，目的是為了探討此一介入方案對住院老年患者認知功能的影響。本研究採隨機分派、單盲測量之實驗性設計，自民國九十七年四月一日起至八月三十日止，於臺北市某醫學中心之骨科病房，以方便取樣法，選取65歲以上，且依排程入院接受髖關節或膝關節置換術之患者共50位，隨機分派至實驗組及控制組各25位。實驗組於住院期間接受「每日探訪及認知刺激活動方案」介入，控制組則接受病房常規照護。本研究以簡易心智狀態檢查（Mini-Mental State Examination, MMSE）為研究工具，於入院24小時內、出院日及出院後一個月進行認知功能評估，並以卡方檢定（Chi-square test）、費雪爾正確概率檢定（Fisher’s exact test）、曼-惠特尼Ｕ檢定（Mann-Whitney U-test）及魏可遜配對組符號等級檢定（Wilcoxon matched-pairs signes-rank test）進行分析。研究結果顯示每日探訪及認知刺激活動：（1）能維持或改善住院老年患者住院期間之認知功能表現，實驗組出院時之MMSE得分較入院時增加1.30分；（2）能使高認知功能之住院老年病患出院後短期內的認知功能表現，維持出院時的水準，但低認知功能者出院後則有下降的趨勢；（3）能減少老年患者住院期間認知功能退化之發生率（12.0% v.s. 44.0%，p＜0.05）。整體而言，每日探訪及認知刺激活動能預防老年患者於住院期間發生認知功能下降，值得臨床醫護人員參考，建議未來的研究可以增加住院期間譫妄之評估及延長出院後之追蹤時間，進一步確認介入效果。

關鍵字

每日探訪 ； 認知刺激活動 ； 住院老年病患 ； 認知功能

並列摘要

Cognitive decline is a common complication in older hospitalized patient. Studies have shown that older hospitalized patients who experienced cognitive decline were about 16 times more likely to develop functional decline. The purpose of this study was to evaluate the effect of daily visit and cognitive stimulation activities on cognitive function of hospitalized elderly.
This study employed a randomized assign and single-blind measurement design. Fifty older patients aged 65 years and older who admitted to a tertiary medical center in northern Taiwan for elective total knee replacement (TKR) or total hip replacement (THR) were recruited from April to August in 2008, and been randomly assigned to experimental or control group. A daily 20 to 30 minutes of visit and cognitive stimulation activities was provided to subjects in the experimental group post surgery till hospital discharge. Subjects in the control group received usual care. The main outcome was cognitive status measured by Mini-Mental State Examination (MMSE) at admission, before discharge and one month post hospitalization. Demographics and clinical information was also collected. The data was analyzed by SPSS software package and Descriptive, Chi-square test, Fisher’s exact test and Mann-Whitney U-test were performed.
The results showed that daily visit and cognitive stimulation activities: (1) could maintain or improve cognitive function for elderly during hospitalization. The MMSE scores of the experimental group showed a improvement of 1.28 points compared with a decline of 0.71 points in the control group (p＜.05). (2) could maintain short-term (from discharge to one month post hospitalization) cognitive function for elderly with high cognitive function at admission. (3) could decrease the incident rate of cognitive decline during hospitalization. Upon discharge, 44% subjects (N=11) in the control group developed cognitive decline (a reduction of≧2 MMSE points), while there was 12% (N=3) in the experimental group (p＜.05). In conclusion, daily visit and cognitive stimulation activities was effective on preventing cognitive decline in hospitalized elderly underwent elective TKR or THR. It will provide the basis for clinical geriatric care.

並列關鍵字

daily visit ； cognitive stimulation activities ； hospitalized elderly ； cognitive function

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