多面向健康促進活動之成效–以C級巷弄長照站老人為例

研究背景：台灣老年人口年齡結構快速高齡化，人口老化相關問題一一浮現。政府為了強化民間社區照顧的能力，衛生福利部自 2005 年就已經推動「社區照顧關懷據點」作為在地老化之社區照顧，之後在2016年底頒佈「長期照顧十年計畫2.0」，計畫中也包含以「社區」為基礎之預防及照顧的C級巷弄長照站。因此，透過規劃高齡健康促進活動來減緩老化對社會衝擊及醫療資源消耗是社區經營者重要課題，提升社區老人生活品質，使年長者能以健康狀態過著圓滿、有貢獻的生活，成為家庭和社會的財富。目的：探討 12週多面向健康促進活動對於C級巷弄長照站老人功能體適能、衰弱風險及長者健康整合式功能評估ICOPE之成效。研究方法：以立意取樣，採類實驗性研究。對象為嘉義縣某醫事C級巷弄站及某社區關懷據點之社區老人，研究對象共82 位，分別為實驗組 57 位、對照組 25位。實驗組以多面向健康促進活動介入，每週 2次，每次 2小時(含前後暖身操 10 分鐘)，共 12週；對照組則維持原有的日常生活及社區活動；兩組於 12 週後進行功能性體適能、Kihon Checklist (KCL) 衰弱篩檢量表及長者整合性照護(ICOPE)後測。本研究運用 SPSS 中文版套裝軟體進行統計分析，運用描述性統計、獨立樣本 t 檢定及成對 t 檢定分析。結果：巷弄站老人參加十二週的多面向健康促進活動後，對於功能性體適能、衰弱風險及心理狀態的提升是有幫助，並且提升成效極佳。實驗組在六項老人功能性體適能、衰弱風險及心理狀態具顯著差異(p＜0.01），然而對照組在前測功能性體適能、衰弱風險及心理狀態等結果表現優於實驗組，但對照組在功能性體適能、衰弱風險及心理狀態後測表現等，未具顯著差異(p > .05）。結論：巷弄站老人參加經過專業人員評估後設計的多面相課程後，對於功能性體適能、衰弱風險及心理狀態的提升是有明顯的幫助，建議在政策上，未來可結合醫護與社工跨領域的專業能力，透過評估規劃出有效的社區健康促進方案。並針對較為衰弱或失能高齡者的家屬，提供支持性服務，試著建立家屬支持管道，建立起家屬支持團體來籌辦家屬與長輩的交流活動。社區專職人力、經營者可制定系統性的培訓課程，針對專職人力與經營者進行培訓與輔導，強化其規劃和執行服務內容的能力。而研究上建議未來可針對不同族群設計不同的活動類型，以便能提供更廣泛的社區老人參與，瞭解及提高不同族群之社區高齡者的生活品質。最後在實務方面，建立起慢性病及健康自我管理，結合專業醫療團隊及資源，包含運動(肌力)、營養、認知促進、慢性病管理(含用藥安全)、防跌及社會參與等服務，並且重視長者心理與靈性並強化參與動機。針對關懷據點志工持續辦理教育訓練，如體適能檢測項目及改善方針、健康飲食的宣導、心理健康的照護，讓內在能力的提升與功能發揮之觀念持續強化於每位志工。最後透過在地資源的整合與連結，同時重塑社區間不同族群間的連結、互動與互助，讓個人和社區將更有活力。

關鍵字

社區老人；多面向健康促進；功能性體適能；介護風險篩檢評估量表(Kihon Checklis) ；長者功能評估量表(ICOPE) ；社區關懷據點； C級巷弄長照站

並列摘要

Background:Taiwan has been shifted to an aging society at the rapid pace, the relevant problems to aging population have emerged over time. In order to increase the ability of caring in the private sectors, the Health and Welfare department has promoted “Neighborhood Caring Point” since 2005, for the caring of local aging neighborhood. After that, the plan of “Long Term Caring 2.0” has been published in the late 2016. The plan included neighborhood cased unit of prevention and caring, and street class C long term caring center. Therefore, by promoting healthy activities to reduce the impact of the society and medical resources usage is considered a highly important topic. The planning of the healthy activities must include physical, psychological, emotional, social and spiritual perspective. Improve the functional work out to reduce the risk of body deterioration. Thus would improve the living quality of the aging population of the neighborhood. As seniors live in healthy life and are able to contribute, they can be the wealth of the family and the society. Purpose:Discussion on the effect of 12 week course of healthy activities, which apply to the seniors. Areas includes body function work out, deterioration risk and ICOPE. Method:Purposive sampling. Research sampling is from the class C street caring station and the seniors of a neighborhood caring point. 82 persons investigated. 57 were in experiment, 25 were to compare. The group involved in experiment applied with healthy activities. Each course of activities lasted 2 hours (include 10 minutes of warm up), Twice a week, total 12 weeks; The group of comparing remain the usual way of life. The 2 groups will undergo the test by Kihon Checklist (KCL), ICOPE and functional fitness. This research used SPSS for statistical analysis, by using descriptive statistics, independent sampling t check and coupling t check analysis. Result:According to the result of the research, there was no difference in performance between the 2 groups prior to the research, which found out by Kihon Checklist and ICOPE. Tests includes 30 second sit and stand (for testing lower body muscle), 2.4 meters step test (for respirational and pulmonary), body bending test on seat (for lower body flexibility), back scratching test (for upper body flexibility) and 2.4 meter round walk test (for balance and agility). Conclusion:After the seniors participated the healthy activities which designed by the specialists, the improvement did observed in function work out, deterioration risk and psychological condition. As for the suggestion in policy making, the specialties from the nurses and social workers can collaborate, and plan the most suitable health improvement plans. Also provide supportive service for those relatively disfuctioned and weaker seniors. Attempt to create the family support channels and establish family support group to hold the activities with seniors. For specialized HR in the neighborhood, the operators can establish the systematic courses. Especially for the experts and operators, to improve their planning and execution ability. Also suggestion can be made for future, in terms of different courses for different groups. Thus many more seniors in the neighborhood can be involved, and better understanding of improve seniors life quality. Finally in the practical point of view, to establish self management in health and long term disease, by combining the medical expertise and resources, including exercise, nutrition, understanding, long term disease management, prevention on fall and social involvement. Emphasis on psychological and spiritual side of the seniors, to improve their motives. The train on relevant volunteers must be in place constantly, which key points are improvement methods, function work out, healthy diet promotion and psychological health caring. Thus would improve the ability of the volunteers. And finally by fusing the local resources, the neighborhood can be more active with interaction between the different groups.

並列關鍵字

Neighborhood seniors ； Multiple aspect health improvement ； Functional fitness ； Kihon Checklis ； ICOPE ； Neighborhood caring points ； Long-Term Care Station C