護理之家老年住民憂鬱現況及其影響因素

背景：憂鬱為老年人常見的健康問題。護理之家老年住民憂鬱盛行率偏高，為社區老人的3至4倍。因此瞭解護理之家老年住民的憂鬱狀況是刻不容緩之事。研究目的：探討護理之家老年住民憂鬱現況及其影響因素。研究方法：本研究使用2009年「護理之家老年住民照護需求」之研究資料，進行次級資料分析。以立意取樣方法篩選出193位研究對象，條件包括：一、居住於立案護理之家；二、年滿65歲及以上；三、居住護理之家滿ㄧ個月及以上；四、認知功能完整者。使用原始研究中的基本屬性、巴氏日常生活活動量表、老年憂鬱量表簡版之資料內容。採SPSS for Window 15.0版統計軟體，進行t檢定、單因子變異數與皮爾森積差相關檢定分析，再將具有統計意義之變項以邏輯迴歸模式進行分析。結果：本研究之老年住民平均年齡為79.44歲(SD=7.42)，女性占59.1%。老年憂鬱量表簡版平均得分為4.26分(SD=4.02)，39.3%有憂鬱情形，身體功能以嚴重依賴者居多(46.1%)。結果也發現，教育程度(t=2.19，p =0.03)、入住護理之家前有無工作(t=3.39， p =0.00)、及入住機構時間(F=3.66，p =0.01)在老年憂鬱量表簡版總得分上有顯著性之差異。另外，身體功能與憂鬱間呈現顯著的負相關(r=-0.20，p =0.00)。而邏輯迴歸模式分析則發現，老年住民入住機構前有工作者的憂鬱勝算為沒有工作者的0.42倍(95% CI=0.22-0.82)，且具有統計上顯著意義(p=0.01)；老年住民身體功能每增加ㄧ分，發生憂鬱的機會為0.98倍(95% CI=0.97-0.99)。結論與應用：本研究發現近40%的護理之家老年住民有憂鬱情形，平均每三人中即有一人出現憂鬱傾向。入住前有無工作及身體功能更是影響其憂鬱發生之重要預測因素。因此，護理之家主管、醫護人員或照顧者應正視老年住民憂鬱問題，於照護過程中，警覺老年住民相關的憂鬱症狀，及早發現問題，並針對入住前無工作以及身體功能較依賴之老年住民特別留意及關心，以便適時發現問題，介入適當護理措施，讓其接受合宜的治療及照護，減少老年住民憂鬱的發生。

關鍵字

護理之家；老年住民；身體功能；憂鬱

並列摘要

Background: Depression is a common health problem in the elderly. The prevalence of depression among older residents in nursing home is 3-4 times higher than older adults in the community. Therefore, it is critical to investigate the prevalence of depression and associated factors among older residents in nursing homes. Purpose: This study is to investigate the prevalence of depression and associated factors among older residents in nursing homes. Method: A secondary-data analysis was applied using the data from “The care needs of older residents in nursing homes” conducted by Chuang in 2009. A purposive sampling method was used and 193 participants were selected. The inclusion criteria were the residents who: (1) lived in the nursing homes; (2) was 65 years old and over; (3) had stayed in the nursing homes for over one month; (4) had intact cognitive functions. Three instruments of the original study were used and data were analyzed including demographic data, Barthel Index, and GDS-SF. The data were analyzed using SPSS version 15.0. Both descriptive and inferential statistical analysis (t-test,one-way ANOVA, Pearson correlation, logistic regression) were performed. Results: The average age of the participants was 79.44 ±7.42 years old and 59.1% of them were women. The average score of GDS-SF was 4.26±4.02. The prevalence of depression was 39.3% found in this study. Regarding functional ability, almost half of the participants were seriously dependent (46.1%). The results also found that participants educational level (t=2.19, p =0.03), working condition before living in nursing homes (t=3.39, p=0.00), and length of stay in nursing homes(F=3.66, p =0.01) had significantly differences in their depression scores. Moreover, there were significantly negative correlation between functional abilities of the participants and their depression scores(r=-0.20, p =0.00). The logistic regression analysis was used to found that the depression odds of the older residents who had a job before living in nursing homes was 0.42 times (95% CI=0.22-0.82) of those who had no job. In addition, older residents had 0.98 times possibilities to have depression (95% CI=0.97-0.99) for each increased score of ADLs (Barthel Index). Conclusion and Implications: This study revealed that nearly 40 percent of older residents who had intact cognitive function in nursing homes had depression. In other words, there was one older resident with depression in every 3 residents in the nursing homes. Working condition before living in nursing homes and functional abilities (ADLs) were important predictors of older residents’ depression. Therefore, managers, physicians, nurses and caregivers in the nursing homes should pay attention to the problem and be alert of, especially for those without job before living in nursing homes and those who are functionally dependent. Early and appropriate nursing interventions should be implemented to reduce the rate of depression among older resident in the nursing homes.