高齡者髖骨骨折術後六個月活動功能預測因子探討

老年為髖部骨折的高危險群，通常需接受手術，諸多因素可能影響老人活動功能的恢復。本縱貫性研究對象為南台灣某醫學中心骨科病房的髖部骨折老人，探討其骨折術後六個月的活動功能預測因子。術後三天收集個人屬性及疾病相關因素、營養、疼痛形及憂鬱情形；並於術後一個月、三個月及六個月收集日常生活活動功能（Activities of daily living, ADL）及工具性日常活動功能（Instrumental activities of daily living, IADL）資料。收案期間為101年6月29日至102年6月28日止，共收案113位。結果:研究對象術後六個月的ADL及IADL在性別、年齡、教育程度、手術方式、術後三天疼痛及憂鬱狀態無顯著差異；在骨折型態，轉子間骨折者術後六個月的ADL及IADL顯著差於股骨頸骨折者；骨折前ADL及IADL執行越好、營養狀態越好，術後六個月ADL及IADL功能就越好。結論:術後六個月ADL的顯著預測因子為術後三天營養狀態、骨折前ADL及IADL、骨折型態，解釋變異量共37.7%。術後六個月IADL的顯著預測因子為術後三天營養狀態、骨折前IADL及骨折種類，解釋變異量共49.2%。建議加強髖部骨折老人骨折前ADL及IADL的評估，並在術後協助病人盡早恢復到骨折前ADL及IADL；並特別注意老人的營養狀況，提供營養的補充及飲食衛教。

關鍵字

高齡髖部骨折；憂鬱；營養；活動功能；複雜性日常生活功能

並列摘要

Older people are at a higher risk of hip fracture and often require surgical treatment. Unfortunately, older people may experience delayed functional recovery. This study explored predictors of functional activities after 6 months of surgery among older adults with hip fracture. We recruited 113 patients with hip fracture who were older than 65 years of age in a medical center in Kaohsiung City in Taiwan. Data collected included patient demographics and disease-related variables, pain levels, nutrition, depression status, activities of daily living (ADL), and instrumental ADL (IADL). Six months after surgery, no significant variations were demonstrated in ADL or IADL according to patients sex, age, education, the type of surgery undergone, or their pain levels 3 days after surgery. Fracture type, prefracture ADL, prefracture IADL, and nutritional status 3 days after surgery were significant predictors of ADL and IADL after 6 months of surgery. These four variables accounted for 37.7% of total variances. Prefracture IADL, nutritional status 3 days after surgery, and fracture type were significant predictors of ADL and IADL after 6 months of surgery. These three variables explained 49.2% of total variances. Based on the research results, we recommend that healthcare personnel assess the prefracture ADL and IADL levels of older people with hip fracture and improve their ADL and prefracture IADL after 6 months of surgery. Healthcare providers should provide care for older adults with poor nutritional status 3 days after surgery.

並列關鍵字

hip fracture ； depression ； nutritional status ； activities of daily living ； instrumental activities of daily living

參考文獻

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Al Ani, A. N., Flodin, L., Soderqvist, A.,Ackermann, P., Samnegard, E., Dalen, N.,... Hedstrom, M. (2010). Does rehabilitation matter in patients with femoral neck fracture and cognitive impairment? A prospective study of 246 patients. Archives of Physical Medicine and Rehabilitation, 91(1), 51-57.

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高齡者髖骨骨折術後六個月活動功能預測因子探討

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