- 學位論文
機構失智老人尿失禁影響因子之模式建構
Causal Model of Urinary Incontinence in Institutional Older Adults with Dementia
摘要
背景：失智症患者罹患尿失禁比例約38%，出現躁動行為比例約34%，而38%有憂鬱症狀。尿失禁、躁動行為及憂鬱會影響患者生活品質並造成主要照護者沉重的負擔。 目的：了解機構失智老人尿失禁主要影響因子、憂鬱症狀及躁動行為相關性及對尿失禁影響性，並建構路徑分析模式。 方法：採橫斷式相關性研究，方便取樣，收案地點為南部長期照護機構。收案條件為(1) 65歲以上，(2)簡易心智狀態問卷調查表(Short Portable Mental Status Questionnaire, SPMSQ)小於8分或經醫生診斷為失智症者。研究變項中尿失禁頻率、躁動行為、憂鬱症狀、認知功能及日常生活功能分別以排尿日誌、柯恩-曼斯菲爾德激動情緒行為量表(Cohen-Mansfield Agitation Inventory; CMAI)、中文版康乃爾失智者憂鬱量表(Cornell Scale for Depression in Dementia, CSDD)、簡易心智狀態問卷 (SPMSQ)及巴氏量表(Barthel Index)測量之。所收集之資料則以結構方程模式（Structural Equation Model, SEM）分析。 結果：本研究共收案258人，最終路徑模型達模式適合度。經模型驗證顯示尿失禁的影響因素為日常生活功能 (β = -0.49, p < .001)、憂鬱症狀(β = 0.12, p = .040)及躁動行為 (β = -0.15, p = .010)。本研究亦發現日常生活功能會經由認知功能及躁動行為間接影響尿失禁；日常生活功能會經由憂鬱症狀間接影響尿失禁；日常生活功能會經由躁動行為間接影響尿失禁。 討論：尿失禁的影響因素為日常生活功能、憂鬱症狀及躁動行為，日常生活功能也能經由各個變項間接影響尿失禁。日常生活功能對認知功能、憂鬱、躁動行為及尿失禁均有顯著性影響，因此若能改善個案日常生活功能均能直接或間接改善尿失禁及上述功能。建議未來研究可依將認知功能或日常生活功能嚴重程度分層討論。
並列摘要
Background: The prevalence rates of urinary incontinence (UI), agitated behaviors, and depressive symptoms in older adults with dementia are 38%, 34%, and 38%, respectively. All of which affect patients’ quality of life and impose a burden on caregiver. Purpose: To explore the relationship among the influencing factors of UI, agitated behaviors, and depression and to construct a structural equation modeling. Method: This study employed a cross-sectional, correlational research design. Participants were recruited through convenience sampling at a long-term care center in southern Taiwan. The inclusion criteria were: (1) aged 65 years or older and (2) Short Portable Mental Status Questionnaire (SPMSQ) score less than 8 or a diagnosis of dementia by physicians. The UI frequency, agitated behaviors, depressive symptoms, cognitive function, and activities of daily living (ADLs) were evaluated using urinary records, the Cohen–Mansfield Agitation Inventory, the Cornell Scale for Depression (Chinese version), the SPMSQ, and the Barthel Index, respectively. The collected data were analyzed through structural equation modeling. Result: In total, 258 participants were recruited. The final version of the model had a good fit (ADLs: β = −0.49, p < .001; depressive symptoms: β = 0.12, p = .040; agitated behaviors: β = −0.15, p = .010). ADLs had an indirect effect on UI via cognitive function and agitated behaviors, an indirect effect on UI via depression, and an indirect effect on UI via agitated behaviors. Discussion: ADLs, depressive symptoms, and agitated behaviors directly influenced UI. ADLs also indirectly influenced UI via the other variables. Furthermore, ADLs were significantly associated with cognitive function, depressive symptoms, agitated behaviors, and UI; therefore, these conditions can be directly or indirectly improved if ADLs are ameliorated. The relationship between ADLs and cognitive functional levels can be investigated in a future study.
參考文獻
延伸閱讀
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