老人髖部骨折出院後六個月長期照護資源的使用:與合併失智症老人之比較

研究目的主要是探討髖關節骨折有無合併失智症老人出院6個月內使用照護服務資源的情形和術後結果以及影響使用之相關因子，以提供醫療照護團隊、病人、家屬以及衛政單位做為參考的依據，使得髖關節骨折的老人在出院過渡期的照護安置上可得到合適的後續照護。研究方法為回溯性研究，利用病歷審查加上自擬半結構式問卷，以電話訪問的方式取得病人的研究資料。研究的對象為南部某家參與計畫之醫學中心，六十五歲以上診斷為為股骨頸和股骨轉子附近骨折，並且手術方式以內固定器開放復位或半人工髖關節置換的病人。收集的時間為2013年1月1日至2014年9月31日止。扣除無效問卷，共得研究樣本104位，分為一組是髖關節骨折沒有合併失智症者70位，另一組為髖關節骨折有合併失智症者34位。研究結果發現髖關節骨折合併有失智症老人相較於無失智症老人，人口學特質上較高齡、與無僅與配偶同住的比例較高、主要照顧者與病患關係為子女或媳婦的比例也較高。髖部骨折無合併失智症老人，出院六個月後入住機構的比例增加了12.9%；而失智症組的病人增加了26.5%的比例。髖部骨折的老人無合併失智症者，出院後6個月內以71.4%首選在宅自顧的照顧型態為主，比失智症者多；而合併有失智症的老人，8.8%首選看護照顧和41.2%首選長期照護服務的比例，是無失智症者的2倍。在曾經使用長期照護服務的個案中，二組使用居家式服務的比例僅有一到二成，而使用機構式的照顧高於八成。合併有失智症者出院後6個月內跌倒比例為23.5%明顯高於無失智症者(8.6%)。與出院六個月內會使用照顧服務資源的重要相關因素為年齡、失智症和主要照顧者的健康狀況，而可以預測使用照顧服務資源的預測因子則為主要照顧者的工作(OR=3.92，95%CI=1.25~12.29)。結論有失智症老人術後在家中較易發生跌倒，未來在執行出院準備服務時，要著重於防跌的衛教。對於髖關節骨折的老人使用外來照顧服務資源有較高需求者，如高齡者、合併有失智症者、主要照顧者健康差者、主要照顧者有工作，要考慮將這些病人列為出院準備服務收案的對象，方能提供病人適切的照護資源及減輕照顧者的照顧負荷。

關鍵字

髖關節骨折；失智症；長期照護服務；照顧服務資源

並列摘要

Purpose This study was designed to survey the care resources utilization for post-hospital care of senile hip fracture cases with or without dementia comorbidity and to study the surgical outcomes and to predict what factors impact the care decisions. The result of this study may provide valuable information for medical team, the patients and their family and even the government to move forward in the aspect of the post-hospital care of elder hip fractures cases. Method We retrospectively collected the cases who was 65 years old or older, received surgical correction for fracture of femoral neck or pertrochanteric region at a medical center in South Taiwan from Janurary 1st 2013 to September 31st 2014. The surgical correction was either open reduction with internal fixation or hemiarthroplasty with prothesis. We collected 104 from medical chart review and questionaires via telephone. 34 were with senile dementia and the other 70 without. Results We found those hip fracture caese with senile dementia were older and had higher percentage to not live with spouses only in comparison with those without dementia and their primary caregivers after hospital discharg were sons, daughters or daughters-in-law. After six months hospital discharged , those elder with senile dementia had 12.9% more to live in care-institutions and those without senile dementia had 26.5% more. As for the 6-month post-hospital care, care-at-home was the principle type (71.4%) for elder hip fracture patients without senile dementia which were much higher than that in those with senile dementia. By the way, the percentages of personal attendants care and long-term care in elder hip fracture with dementia were 8.8% and 41.2% respectively, which were around twice the figure in those without dementia. Home care was low as 10%~20% in both groups which had long-term care and institutional care was the dominant type around 80%. Falling in the 6-month post-hospital care is higher (23.5%) in elder hip fracture cases with dementia than that (8.6%) in those without. The factors associated with care resources utilization of the 6-month post-hospical care include age, dementia and health status of the primary caregivers. The factor predicting use of care resources is the job-requirement of the primary caregiver. (OR=3.92, 95%CI=1.25~12.29) Conclusions For hospital discharge planning with hip fracture cases is aimed to prevent another falling at home, comorbid dementia especially . Higher demend for external care resources exists in patients with older age, comorbid dementia, poor health status of the primary caregivers or job-requirement of the primary caregivers. These patients are the high risk cases requiring to cope with while making hospital discharge planning in order to provide appropriate care resources the patients need and to ease the caregiver burden.

並列關鍵字

Hip Fracture ； Dementia ； Long-term Care ； Care Resources

參考文獻

Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis, 40(5), 373-383.

參考文獻