長期照護機構輪椅倚賴失智老人之身心健康現況及其相關性探討

背景：人口高齡化為國家社會帶來極大的衝擊，然而失智症老人因身體功能的老化及疾病的進行造成身心功能的問題產生，而喪失自我執行日常生活功能的能力。瞭解輪椅倚賴失智老人之身心健康相關性，將有助於提升長期照護機構的照護品質。目的：探討長期照護機構輪椅倚賴失智老人之身心健康現況及其相關性，並找出影響日常生活功能的預測因子。方法：採描述、相關性研究，以方便取樣，選取高雄市及屏東縣市政府立案之公私立長期照護機構，共6家進行，共選取98位輪椅倚賴失智老人，以結構式問卷調查方式(簡易智能評估表、巴氏量表、失智者憂鬱觀察量表、失智者問題行為觀察量表)及功能性體適能測量(心肺功能、身體柔軟度、關節活動度、肌力及肌耐力)進行資料收集。結果：長期照護機構輪椅倚賴失智老人在身體健康方面：肺活量、肩臂柔軟度、坐姿體前彎、上肢肌力(手握力)、上肢肌耐力與日常生活功能呈顯著正相關(r = .51, p < .001 ; r = .29, p = .003; r = .52, p < .001; r = .43, p < .001; r = .51, p < .001)。在心理健康方面：憂鬱與問題行為呈顯著正相關(r = .36, p < .001)。問題行為、肺活量、憂鬱及上肢肌耐力為日常生活功能之重要預測因子，共可解釋66.30%之總變異量。討論：經由以上研究結果，可提供健康照護專業人員了解長期照護機構輪椅倚賴失智老人之身心健康相關性參考，建議未來研究能發展相關輪椅倚賴失智老人體適能活動之介入措施，以減緩輪椅倚賴失智老人身心功能的退化的發生。

關鍵字

輪椅倚賴失智老人；身體健康；心理健康；長期照護機構

並列摘要

Background：The ageing population has brought great impact on many countries. Ageing often causes physical deterioration leading to functional dependency to various degrees among the elderly. The dementia older adults due to aging and disease caused by the body function reduce in physical function, and this is associated with depression and problem behaviors, loss of ability to self-perform daily life function. The understanding of the status and correlations on the physical and psychological health of whellchair-bound and demented older adults will help to improve the quality of care in long-term care facilities. Objective: This study was to explore and indentify the differences on the status and correlations on the physical and psychological health of wheelchair-bound and demented older ddults in long-term care facilities,and to identify the impact of a predictor of daily living. Methods:A mining descriptive, and correlation research design was applied in this study. Using convenience sampling, 98 wheelchair-bound seniors were recruited from Kaohsiung and Pingtung cities of total six government public and private long-term care facilities. Data was collected using a structured questionnaire interview and , measure physical fitness, which included Mini-Mental State Examination(MMSE), Barthel Index(BI), Cornell Scale for Depression in Dementia(CSDD), Clifton Assessment Procedures for the Elderly-Behavior Rating (CAPE-BRS). Result: For the aspect of physical health that vital capacity, a back scratch test, chair sit and reach test, hand grip strength, upper muscle endurance were positively correlated with the activity of daily living (r = .51, p <.001, r = .29, p = .003, r = .52, p <.001, r = .43, <.001, r = .51, p <.001). For the aspect of psychological health, depression was positively correlated with problems behavioral (r = .36, p <.001).Multiple regression analysis further showed that the predictors of activity of daily living included problem behavior, vital capacity, depression and upper limb muscle endurance, accounted for 66.30% of the total activity of daily living variance. Discussion: the physical and psychological health were multi-faceted and complex for demented olders. The study findings as proven,may serve as reference in nursing care, teaching and research. In this study, we suggested that the development and application interventions to improve physical and psychological health of wheelchair-bound and demented older adults in long-term care facilities should be emphasized.