協助一位社區衰弱長者以實證介入方式改善下肢肌力延緩失能之照護經驗

Using Evidence-Based Nursing to Improve Lower Limb Muscle Strength and Delay Disability in Community-Dwelling Older Adults with Frailty

潘雯秀(Wen-Shiou Pan) ； 陳妙言(Miao-Yen Chen)

《榮總護理》 38卷1期 (2021/03) Pp. 63-70

https://doi.org/10.6142/VGHN.202103_38(1).0007

摘要

衰弱症為失能前兆，常伴隨整體功能衰退之特性，當身體無法維持恆定，導致失能、住院、依賴、甚至死亡等不良結果，進而增加社會照護成本與家庭負擔。本文為一位社區衰弱長者因頭暈致使跌倒造成腦部出血，於照護期間2020年2月17日至2020年6月6日，運用周全性老年評估收集相關資料。期間共進行11次家訪，進行由醫院出院返家到社區居家之完整照護經驗。確認病人健康問題有潛在危險性跌倒、功能性尿失禁、自我照顧能力缺失、活動無耐力、定向感及記憶功能障礙及營養不良。以實證護理的概念，去探討肌力訓練是否能夠改善下肢無力及衰弱的情形，依據評讀文獻後設計出符合個別性之介入措施，使整體功能有顯著進步，包含有下肢肌肉力量、6公尺直線行走、營養狀態及認知功能，更難得的是ADL由住院時的40分進步至70分，可自行進食、如廁及使用四腳助行器行走且步態平穩，期間無跌倒情形發生，進而解決健康問題，達成改善下肢肌力及延緩失能之目的。

關鍵字

衰弱 ； 周全性老人評估 ； 下肢肌力訓練 ； 實證護理

並列摘要

Frailty is a precursor of disability, and it is often accompanied by the characteristics of overall functional decline. The inability of an individual's body to maintain a constant level of functionality leads to disability, hospitalization, dependence, and even death, which increase social care costs and the burden on the individual's family members. This paper reviews the case of an elderly adult with frailty in the nearby community who experienced dizziness that led to a fall that resulted in brain hemorrhage. During the nursing care period from February 17, 2020, to June 6, 2020, a comprehensive geriatric assessment was performed to collect relevant data. During this period, a total of 11 home visits were conducted to complete the care experience from the hospital discharge to the return to the community home. The patient's health problems included a history of potentially dangerous falls; functional urinary incontinence; inability to independently perform the self-care activities of bathing, eating, and using the toilet; generally impaired activity; and impaired orientation and memory. Using the concept of empirical nursing, we explored whether muscle strength training could reduce the weakness of the lower limbs. The individual intervention measures were based on a review of the literature and were designed to substantially improve the overall function and muscle strength of the lower limbs, the ability to walk in a straight line, nutritional status, and cognitive function. Notably, the patient's activities of daily living assessment score improved from 40 to 70 points during hospitalization. The patient was able to eat independently, go to the toilet, and walk with a four-legged walker with a stable gait. No falls occurred during the treatment period. The interventions resolved the patient's health problems, successfully improved the muscle strength of the lower limbs, and delayed disability.

並列關鍵字

frailty ； comprehensive geriatric assessment ； lower limb muscle strength training ； evidence-based nursing

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