比較護理之家與社區老人睡眠品質及其影響因子之研究

本研究目的主要為探討護理之家與社區老人的睡眠品質及其影響因子。進一步比較護理之家老人與社區老人在睡眠品質及其影響因子之差異，以及探討護理之家老人與社區老人睡眠品質的預測因子及其差異。本研究方法為横斷式調查法，針對護理之家和社區老人，以結構式問卷來蒐集資料，進行分析討論，以比較不同生活背景的老人之睡眠品質及其影響因子。研究樣本分別是：1.護理之家老人：以某家區域醫院所附設之護理之家為研究場所。2.社區老人：以該醫院所負責之整合性篩檢服務社區村里為場所，管轄區域以桃園巿北區10個村里為主。共收案124名，所收集之資料以SPSS19.0統計軟體進行資料建檔，並以t-test、Chi-square、ANOVA、Pearson’s correlation、Multiple Regression進行資料分析。研究結果顯示：一、整體睡眠品質方面，全體研究對象的睡眠品質總分為7.2、睡眠品質不佳（PSQI>5）的占58.9%；護理之家老人的睡眠品質不佳的比例顯著高於社區老人（93.3% vs 47.9%）。二、護理之家老人的睡眠品質在主觀睡眠品質、睡眠潛伏期、睡眠效率、使用安眠藥及日間功能障礙的平均得分均顯著高於社區老人。三、護理之家具以下特質之老人睡眠品質較差：女性、服用鎮靜安眠藥、每週相對身體活動總量較低者、每週相對睡眠活動量較高者。經逐步迴歸分析顯示，服用鎮靜安眠藥及性別對於護理之家老人睡眠品質的聯合解釋量可達37.6%，其中以服用鎮靜安眠藥對於睡眠品質有較大的預測力，可以解釋全部變異量的25.6%。四、社區具以下特質之老人睡眠品質較差：罹患慢性病總數較多者、有干擾睡眠症狀、服用鎮靜安眠藥、服用支氣管用藥、每週相對睡眠活動量較低者、每週相對輕度活動量較低者、環境光線干擾度及噪音干擾度較大者。經逐步迴歸分析顯示，服用鎮靜安眠藥、每週相對輕度活動量、環境光線干擾度、罹患慢性病總數、干擾睡眠症狀、服用支氣管用藥、噪音干擾度等7個變項對於睡眠品質的聯合解釋量可達54.7%，其中以服用鎮靜安眠藥可以解釋全部變異量的17.4%。

關鍵字

睡眠品質；護理之家老人；社區老人

並列摘要

The main purpose of this research is to investigate the sleep quality and its related factors of the elderly living in nursing home and community dwelling. In this thesis we compared the difference of the sleep quality and its related factors and predictors of the sleep quality between the elderly living in nursing home and community dwelling. The method of this research is cross-section study. Subjects who met the selection criteria were recruited in the study. In total, 124 subjects (nursing home n=30; community dwelling n=94） participated in the study. Three instruments including “Pittsburgh Sleep Quality Index”, “Seven-day Physical Activity Recall”, and ”Geriatric Depression Scale Short Form” were used for data collection. Data were analyzed with SPSS for windows 19.0 software. The statistics methods were used in the study including t-test, Chi-square, ANOVA, Pearson’s correlation, and multiple regression. The results of this research shows: 1. For the total sleep quality, the whole samples score was 7.2. The samples with low sleep quality account for 58.9%. The proportion of low sleep quality in nursing home is higher than community dwellings. 2. The subjects’ average scores in overall sleep quality, sleep latency, sleep efficiency, and day dysfunction due to sleepiness were higher in nursing home than community dwellings. 3. The elderly in nursing home with the following properties are with the lower sleep quality: female, taking sedations for sleep, relatively low amount of physical activity per week, relatively high amount of sleeping activity per week. With multiple regression method, it shows that taking sedations for sleep and gender can explain 37.6% of total sleep quality variance. Particularly, taking sedations for sleep was a stronger predictor of the sleep quality that is able to explain 25.6% of sleep quality variance. 4. The elderly in community dwellings with the following properties are with the lower sleep quality: suffering more chronic diseases, sleep disturbance symptoms, taking sedations for sleep, taking bronchial medicine, relatively low sleeping activity per week, relatively low amount of mild physical activity per week, more disturbances by light and noise. With multiple regression method, the seven factors, taking sedations for sleep, relatively low amount of light physical activity, disturbance by light, total number of chronic diseases suffered, sleep disturbance symptoms, and taking bronchial medicine, explain 54.7% of total sleep quality variance. Particularly, taking sedations for sleep is able to explain 25.6% of total sleep quality variance.