老年人各項日常生活活動功能與自評健康狀態之調查及相關性探討

Assessment of Individual Activities of Daily Living and Its Association with Self-rated Health Status in Elderly People

胡愈寧(Yu-Ning Hu) ； 酈欽菁(Chin-Ching Li) ； 李佳(Chia Lee) ； 林榮輝(Rung-Huei Lin) ； 胡國琦(Gwo-Chi Hu)

《台灣復健醫學雜誌》 37卷2期 (2009/06) Pp. 107-114

https://doi.org/10.6315/2009.37(2)04

摘要

老年人的健康狀況除了生理上沒有疾病和心理、社會諸多層面的安適之外，尚須維持良好的功能狀態。在評估老年人的功能狀態時，常用基本日常生活活動和工具性日常生活活動功能量表的總分或單一特定項目來評估，很少研究針對量表內個別項目的功能狀態和健康狀態作相關性探討。本研究主要目的是要了解老年人在日常生活活動功能量表中各項活動功能障礙的盛行率，並分析各項活動的功能狀態與其自評健康狀態之相關性。
本研究採橫斷面研究方法，以苗栗縣所有65歲以上老年人作爲研究母群體，採分層隨機抽樣的方法，共得到600位樣本，其中男性302人，女性298人。資料收集是由經過訓練之訪察員到家進行訪查得到，包括受訪者的基本資料、各項基本日常生活活動和工具性日常生活活動的功能狀態、和自我評估健康狀態等。
結果發現72.3%的老年人自我評估健康狀態爲尚可、好、或非常好，27.7%的老年人自評健康狀態爲不好或非常不好。在基本日常生活活動功能方面，「上下床」有功能障礙者(9.3%)最多，而「進食」有功能障礙者(7.0%)最少；在工具性日常生活活動功能方面，「外出行動能力」有功能障礙者(24.7%)最多，而「藥物處理」有障礙者(16.8%)最少。單變項分析結果顯示自評健康狀態和全部基本日常生活活動項目「外出行動能力」和「藥物準備」等項目的功能狀態有相關，複邏輯迴歸分析顯示「進食」、「大小便控制」、「穿脫衣服」、「上下床」、「洗澡」、「外出行動能力」和「藥物準備」等項目的功能狀態都和自評健康狀態有獨立相關，其中以「大小便控制」（危險對比值：4.72）和「進食」（危險對比值：4.27）項目的功能狀態和健康狀態相關性最強。針對和老年人健康狀態有顯著相關的日常生活活動，應該積極介入防止功能喪失，或藉由復健治療使喪失的功能恢復，以提升老年人的自我評估健康滿意度。

關鍵字

日常生活活動 ； 自評健康狀態 ； 老年人 ； 復健

並列摘要

Health-related quality-of-life in the elderly generally encompasses freedom from disease, good physical and psycho-social well-being, and preventing the loss of function in activities of daily living (ADL). Some indices of ADL, such as basic ADL and instrumental ADL, are considered to be measures of functional status in the elderly. However, in most studies, functional status is evaluated by either the summed ADL score or disability score in one or more ADLs. No studies have investigated the association between an individual's ADL function and self-rated health status. The purpose of this study was to investigate the relationship of functional status (i.e., 13 ADL items in the basic and instrumental ADL domains) to self-rated health status in elderly people.
All residents aged 65 years old or older in Miaoli city were chosen for this study. All subjects in the sample of 600 individuals were selected by a stratified systematic random sampling method and interviewed by trained interviewers. Data on demographic variables, functional status in basic and instrumental ADLs, and self-rated health were collected.
The results showed that self-rated health status was excellent, good, or fair in 72.3% of the elderly, and bad or poor in 27.7%. The most and least prevalent disabilities in basic ADLs were transfer (9.3%) and feeding (7%), respectively; the most and least prevalent disabilities in instrumental ADLs were transportation (24.7%) and drug preparation (16.8%). Multiple logistic regression analysis showed that functional status in bathing, feeding, dressing, incontinence, transfer, transportation, and drug preparation was significantly associated with self-rated health status, with incontinence (odds ratio, 4.72) and feeding (odds ratio, 4.27) being highly associated.
An effort should be made to prevent functional decline in ADLs significantly associated with self-rated health status activities. Rehabilitation therapy should be focused on restoring independence in these activities, which subsequently would improve self-rated health status.

並列關鍵字

activities of daily living ； self-rated health status ； elderly ； rehabilitation