以周全性老人評估探討老化衰弱及踏步機運動計劃介入成效之系列研究

高齡化是全球性的議題，由於系統功能的衰退，老年人成為健康照護和長期照護的主要使用族群。周全性老人評估能針對老年人的生理、心理認知狀況和生活功能進行整體性的評估，發現老年人潛在的健康問題，藉此可進一步介入各專業的照護計畫。周全性老人評估並能確認老人衰弱的危險性，藉個別化運動介入給予改善，降低及改善老化有關的老衰退化。本研究為一系列以周全性老人評估探討老化衰弱，並以踏步機運動計劃介入，以瞭解其在改善老人衰弱程度之成效。本研究分成三階段進行，第一階段首先將現有的理論性及研究性文獻進行分析及綜合，並以綜合的知識為基礎，套用羅氏適應模式，發展一個老化衰弱適應模式的中型理論；為發展老化衰弱評估模式，以期發展個別性老人照護計畫，第二階段因此根基於周全性老人評估，進一步發展老化衰弱指標及進行臨床效度測試，以提供臨床實務應用上之參考；第三階段藉由所發展之周全性老人評估老化衰弱指標，瞭解65歲（含）以上老人老化衰弱（包含整體功能能力、心理認知健康及生理健康）情形，並探討老人踏步機運動計劃，對65歲（含）以上老人老化衰弱的短期影響，測試其對改善老人衰弱之成效。最後階段研究者以台北地區某教學醫院門診老年病患為研究母群體，進行為期八週之實驗研究，以周全性老人評估（包含整體功能能力、心理認知健康及生理健康三部分老化衰弱）施測，評估老人整體狀況後，介入以心跳儲備法60－80％之目標心跳率或運動自覺強度13－15之踏步機訓練，每週二次，每次30分鐘運動計劃共八週，並以周全性老人評估方式評估其整體功能能力、心理認知健康及生理健康的改善程度，做為運動計劃設置之依據，且於第八週進行成效之評估。本研究實驗組收案15人，對照組收案21人，以前測值為共變數，進行單因子共變數分析，結果發現在六分鐘行走測試 [ F（1, 34）= 4.75, p = .04 ]、身體質量指數 [ F（1, 34）= 4.58, p = .04 ]、腰臀比 [ F（1, 34）= 4.60, p = .04 ]、體脂肪率[ F（1, 34）= 4.61, p = .04 ]及三米來回行走測試 [F（1, 34）= 4.49, p = .04 ]，二組之後測值達顯著差異，在整體功能能力中的「日常生活功能」及「工具性日常生活功能」、心理認知健康中的「憂鬱程度」及「認知程度」、生理健康中的「日常生活活動及工具性日常生活活動疲憊程度」、「用力肺活量」、「第一秒吐氣容積」、「一秒率」、「握力體重指數」皆未達顯著差異。本研究以周全性老人評估之老化衰弱指標可提供護理人員評估老年人老化衰弱狀況，透過訓練結果回饋以強化其運動動機，並瞭解執行老人運動計劃對改善老人健康狀況之成效，能作為設計老人運動計劃及規劃老人健康促進活動時之參考。

關鍵字

運動計劃；周全性老人評估；老化衰弱

並列摘要

Aging is a global issue. With the systematic decline of the functioning, elderly is the target population for health care and long-term care services. Comprehensive Geriatric Assessment (CGA) is well known to be able to comprehensively assess the physical and psychological health and physical functions of the elderly in order to identify potential health and care problems which can be intervened by the multidisciplinary care team. Components of CGA can be used to identify risk for frailty among the elderly which might be improved through exercise intervention. Regular exercise was found to be effective in improving the functioning and delaying the aging-related degradation. The purpose of this serial of studies was to explore the application of Comprehensive Geriatric Assessment in frailty and testing the effectiveness of stepper exercise program. There were three phases in this serial of studies. In phase one, we developed a middle-range nursing theory of adaptation for frailty. Theoretical substruction was used to deduce the adaptation for frailty from the Roy’s adaptation model. Theoretical and research literature findings were synthesized to provide the foundational, theory-building strategies which would be used to develop the adaptation for frailty. In phase 2, to apply components of CGA, we developed the frailty indicators for the older adults. This study was to establish the clinical validity of the frailty assessment tools in order to propose the feasible application for clinical practice in Taiwan. Finally, an experimental research design would be utilized in phase 3. CGA was used to evaluate the degree of frailty among the elderly. The sample of this study was the elderly recruited from a teaching hospital out-patient centers in northern Taiwan. The eligible participants were assessed with CGA. The effectiveness of stepper exercise program in improving frailty among dwelling elderly using components of CGA (include overall physical function performance and physiologic and psychological health domains) were explored. Subjects were asked to have 30 minute stepper exercise with exercise intensity of 60－80％ target heart rate measured by heart rate reserve method or 13－15 rating of perceived exertion twice per week in the research center. Benefits of the exercise based on results of CGA were feedback to participants in each session. The effectiveness of the program would be evaluated in 8 weeks. A total of 36 elderly, 15 in experimental and 21 in control group completed the program. ANCOVA was calculated to control for the effects of pre-test data on the dependent variables. The results of the study revealed that after controlling the covariance of pre-test data, 6MWT [ F(1, 34) = 4.75, p = .04 ], BMI [ F(1, 34) = 4.58, p = .04 ], waist-hip-ratio [ F(1, 34) = 4.60, p = .04 ], body composition percentage [ F(1, 34) = 4.61, p = .04 ], and 3 M up and go test [ F(1, 34) = 4.49, p = .04 ] improved after 8 weeks exercise training were observed in experimental group. However, measurements of Barthel Index, IADL scale, GDS, MMSE, perception of fatigue of ADL and IADL vision scale, FVC, FEV1, FVC/FEV1, hand-grip body weight ratio showed no significant improvement. Results of this study would be applied for future care planning to make use of CGA in frailty and improve the health of the elderly.

並列關鍵字

exercise program ； Comprehensive Geriatric Assessment ； frailty

參考文獻

Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist, 9(3), 179-186. doi:10.1093/geront/9.3_Part_1.179

Lee, E. G., Choi, J. H., Kim, K. E., & Kim, J. H. (2014). Effects of a Walking Program on Self-management and Risk Factors of Metabolic Syndrome in Older Korean Adults. Journal of physical therapy science, 26(1), 105-109. doi:10.1589/jpts.26.105

中文部分