- 學位論文
探討住院高齡病人身體功能、跌倒風險與衰弱之相關性
The correlations among physical performance, fall risk & frailty in hospitalized older patients
摘要
衰弱為老化過程中功能衰退及失能的前驅症狀，容易造成跌倒、臥床不動、失能、反覆住院、機構化等不良後果。而住院之高齡病人又因臥床、固定不動及急性期的侵入性治療等因素，導致其身體功能下降，增加其跌倒風險。而一旦有跌倒經驗，又容易造成臥床情形增加，進而使得身體功能持續惡化，衰弱情形加劇。目前少有研究針對住院高齡病人進行探討身體功能、跌倒風險及衰弱的關聯，故本研究目的在探討南臺灣某區域教學醫院住院高齡病人其身體功能、跌倒風險與衰弱之相關性。 本研究為一橫斷式相關性描述性研究，自2017年10月至12月間針對南臺灣某區域醫院65歲以上之住院老人為對象，方便取樣105人，利用巴氏量表、握力計、坐站起走測試及30秒坐站測試收集住院高齡病人之身體功能表現，運用艾德蒙衰弱評估量表(Edmonton Frail Scale)瞭解受試者衰弱程度，應用跌倒風險評估量表(PH-FRAT)評估受試者之跌倒風險。完成資料收集後，以SPSS進行統計分析，運用描述性統計說明住院高齡病人衰弱風險程度、身體功能程度及跌倒風險程度，以推論性統計分別討論住院高齡病人基本屬性、身體功能及跌倒風險在衰弱的差異性，最後再分析住院高齡病人身體功能、跌倒風險及衰弱之相關性。 本研究105名受試者中，無衰弱者有40人(38.1%)、衰弱前期34人(32.4%)及衰弱31人(29.5%)。日常功能得分(r= -.41, p<.01)、握力表現(r= -.38, p=.001)及30秒坐站測試所得次數(r=-.38, p<.01)和衰弱得分有負相關，而坐站起走測試所得秒數(r= .15, p=.16)與衰弱得分無顯著相關；而跌倒風險(r= .29, p=.002)與衰弱得分有正相關。日常功能得分(r=-.29, p=.002)與跌倒風險有負相關；而握力(r=-.17, p=.09)、坐站起走測試(r=.17, p=.12) 及30秒坐站測試所得次數(r=-.06, p=.55)則與跌倒風險無顯著相關。 臨床護理人員應於病人入院時，加強評估病人身體功能狀態，特別是日常功能(ADL)，並進行衰弱評估，以期早期發現有無身體功能下降情形，判斷是否為衰弱個案，及早給予衰弱相關護理措施，降低住院期間跌倒風險。
並列摘要
Frailty is the precursor to functional decline and disability during the aging process, which can easily lead to adverse consequences such as falls, immobilization, disability, repeated hospitalization, and institutionalization. The older inpatients also suffer from factors such as bed rest, immobility, and invasive treatment during the acute stage, and all of these could result in physical function decreasing and risk of falls increasing. However, once there is a fall experience, it will easily lead to prolong time of bedridden, worsen physical functions and exacerbate frailty. At present, few studies have examined the association between physical function, falls risk, and frailty in elderly inpatients. Therefore, this study aims to explore the correlation between physical functions, fall risk, and frailty of hospitalized older patients in a Regional Teaching Hospital of the Southern Taiwan. This study design was descriptive, cross-sectional. From October to December 2017, we recruited 105 inpatients, aged over 65 years old in a Regional Teaching Hospital of the Southern Taiwan. To collect physical function of older inpatients by Barthel Index, hand grip, timed up to go test and 30 seconds sit to stand test, to understand extent of frailty by Edmonton Frail Scale, and assessment risk of fall by applying fall risk assessment tool (PH-FRAT). After completing the data collection, SPSS was used for statistical analysis. Descriptive statistics were used to describe the degree of ftailty, physical function and fall risk of older inpatients. The inferential statistics were used to discuss the basic attributes, physical function and fall risk of older inpatients, and finally analyzed the difference among physical function, fall risk and frailty in older inpatients. Among the 105 subjects in this study, 40 (38.1%) were non-frail, 34 (32.4%) showed pre-frail and 31 (29.5%) were frail. Barthel Index scores (r=-.41, p<.01), hand grip strength (r=-.38, p=.001) and the number of 30-second sitting test (r=-.38, p<.01) showed negative correlation with frailty scores, and the results of timed up to go test (r = .15, p =.16) was not significant with frailty score; the risk of fall (r =.29, p=.002) showed positive correlation with frailty. Barthel Index scores (r=-.29, p=.002) were negatively correlated with fall risk, hand g11rip strength (r=-.17, p=.09), timed up to go test (r=.17, p=.12) and 30 seconds sit to stand test (r=-.06, p=.55) showed no significant associated with the risk of falls. In clinically, nurses should strengthen the assessment of the patient's physical state, especially the daily function (ADL), and assess the frailty status when the patient admitted, in order to find out whether there is a decline in physical function in the early stage, determine whether it is a frailty case, and provide nursing intervention for frailty care, to reduce the risk of falls during hospitalization.