中部某醫學中心門診慢性病患老年人之失能風險相關性研究

Association Disability Risk of Elderly Patients with Chronic Diseases in the Outpatient Clinic of a Medical Center in Central Taiwan

蔡曉薇(Hsiao-Wei Tsai)

指導教授 ： 陳曉梅

中山醫學大學/醫學院/護理系長期照護碩職專班/碩士(2023年)

https://doi.org/10.6834/csmu202300022

摘要

研究背景：
全球人口老化，老年人慢性疾病之罹病率逐漸增加，於門診有近一半的老年人有較高的失能風險。故探討影響失能風險的因素有其必要性。老年人為控制其慢性病，常需依賴正式、非正式之社會支持，然而，社會支持是否為影響慢性病患老年失能風險之預測因子未有定論。
研究目的：
探討高齡門診慢性病患老年人人口學基本資料、健康情形及社會支持，對於失能風險的相關性以及影響失能風險之重要預測因子。
研究方法：
研究採橫斷式、相關性研究設計。研究對象為中部某醫學中心之高齡門診慢性病患65歲及以上老年人，採方便取樣，使用結構化問卷，以門診慢性病患老年人社會人口學資料、健康情形、社會支持量表來收集數據，共收案175位罹患慢性病患之老年人，此外，研究結果以SPSS 26.0電腦套裝軟體進行分析，並採逐步迴歸（Stepwise regression）統計方式分析失能風險之預測因子。
研究結果：
慢性病患老年人失能風險平均分數7.10 ± 4.40分（總分25），得分指標28.4%，社會支持平均分數44.79分± 10.21 (總分60分)，得分指標74.8%。從逐步迴歸分析結果顯示：整體迴歸模式可解釋失能風險達48.9% (調整後R2= 0.489)的變異情形，年齡 (2.5%)、性別 (2.3%)、生活費用充裕/大致夠用 (1.1%)、慢性病數量 (0.3%)、因尿失禁影響生活 (8.1%)、AD8 (Alzheimer disease 8) >2 (24.6%)、每週運動次數1-2次/週 (1.5%)、每週運動次數 > 3次/週 (3.6%)、親友評價性社會支持 (2.2%)，是影響門診慢性病患老年人失能風險最主要的預測因子。
結論/實務應用：
為降低慢性病患老年人之失能風險，醫療團隊應及早進行慢性病患老年人AD8篩檢，以預防失智風險，並針對女性、慢性病數量愈多、因尿失禁影響生活、生活費用不足夠、無運動習慣及親友評價性社會支持愈低者，應提供適當的強化老年人之經濟功能，促進其運動的次數，強化親友鼓勵與尊重老年人的決定，以降低慢性病患老年人失能之風險。

關鍵字

慢性病老年人 ； 失能風險 ； 社會支持

並列摘要

Background:
The world’s population is aging. In Taiwan, the elderly population aged 65 years and over accounted for 16.07% of the overall population in 2020. As the elderly age, the prevalence of chronic diseases in the elderly gradually increases. Nearly half of the elderly with chronic diseases in the outpatient department have higher risks of disability.Therefore, it is necessary to explore the factors that affect the risk of disability. In order to control their chronic diseases, the elderly often need to rely on formal and informal social support. However, whether social support is a predictor of disability risk in elderly with chronic diseases remains inconclusive.
Purpose:
This study explored the correlation of the basic demographic data, health status, and social support with important predictors affecting the risk of disability among the elderly with chronic diseases in the geriatric outpatient department.
Method:
This study adopted a cross-sectional. The participants were elders with chronic diseases in the geriatric department of a medical center in central Taiwan. Elderly patients with chronic diseases over 65 years old in a medical center in central Taiwan. Correlational research design, convenience sampling and structured questionnaire survey were applied.The data were collected from the basic demographic data, health status, social support scales, and kihon checklist (KCL) of the elderly with chronic diseases in outpatient clinics, a total enrollment of chronic diseases participated was 175. In addition, the research results were analyzed with SPSS 26.0 computer package software, and the predictors of disability risk were analyzed by stepwise regression statistical method.
Result:
The average score of disability risk for the elderly with chronic diseases was 7.10 ± 4.40 points (total score 25), and the score indicator was 28.4%. The average score of disability risk for the elderly with chronic diseases was 7.10 ± 4.40 points (total score 25), with a score indicator of 28.4%, and the average score of social support was 44.79 ± 10.21 points (total score of 60 points), with a score indicator of 74.8%. The results of stepwise regression analysis show that the overall regression model could explain approximately 48.9% of the variation of the disability risk. (adjusted R2= 0.489), age (2.5%), sex (2.3%), cost of living sufficient/roughly sufficient (1.1%), number of chronic diseases (0.3%), urinary incontinence affects life (8.1%), AD8 (Alzheimer disease 8) >2 ( 24.6%), weekly exercise times 1-2 times/week (1.5%), weekly exercise times > 3 times/week (3.6%), and evaluative social support from relatives and friends (2.2%) were the most important predictor of disability risk among elderlies with outpatient chronic diseases.
Conclusion/ practical application:
In order to reduce the risk of disability in the elderly with chronic diseases, the medical team should conduct AD8 screening for the elderly with chronic diseases as soon as possible to prevent the risk of dementia, and for women, the more chronic diseases, urinary incontinence affects life, insufficient living expenses, no exercise habits, and low evaluative social support from relatives and friends, should provide adequate economic strengthening for the elderly,promote the frequency of their exercise, strengthen relatives and friends to encourage and respect the decisions of the elderly, to reduce the risk of disability in the elderly with chronic diseases. The research results can serve as a reference for clinical staff and community health workers and as a basis for research in the future.

並列關鍵字

Elderly with chronic diseases ； Risk of disability ； Social support

參考文獻

Cobb, S. (1976). Social support as a moderator of life stress. Psychosomatic Medicine, 38(5), 300-314. https://doi.org/10.1097/00006842-197609000-00003

中文參考資料

王瑜欣（1993）．類風濕性關節炎患者生活品質及其相關因素之探討〔未發表碩士論文／國防醫學院護理學研究所〕。

內政部戶政司（2021）．年底人口三階段年齡結構、依賴比、老化指數及扶養比。 https://www.ris.gov.tw/info-popudata/app/awFastDownload/file/y1s4-00000.xls/y1s4/00000/

行政院主計總處（2021，12月）．國情統計通報。https://www.stat.gov.tw/public/Data/112616244W75YTOW0.pdf