以老人身體活動指標推估社區老人物理治療需要

Estimating the need of physical therapy among the community elderly by Elderly Mobility Index

周雅惠(Ya-Hui Chou)

指導教授 ： 徐慧娟

亞洲大學/健康學院/健康管理研究所/碩士(2005年)

摘要

本篇研究目的為發展適合篩選社區老人身體功能的量表(EMI)，及利用量表的評估來了解社區老人身體功能的情形，並針對有身體功能障礙的老人，分析其影響因素，並對應物理治療需要，以了解社區老人物理治療需要的情形。
本研究是利用93年度國科會專題研究「台灣老人成功老化研究計畫（Ⅱ）」的資料進行分析，研究對象是以年滿65歲以上，居住在苗栗市、通霄、後龍、公館、卓蘭的老人為抽樣母群體。採取3段分層抽樣法，挑選720位老人參加研究，經由招募當地訪員實際進行訪問，調查時間約1個月。整個過程由輔導人員協助完成，共完成584份，問卷完訪率為81.1%。問卷資料分析過程，先針對發展的量表以因素分析進行分類，在以獨立 t 檢定與ANOVA檢定、複迴歸的方式來探討影響身體功能的因素。並結合ADL、IADL、EMI的身體功能表現，利用相關係數進行整合，同時考量因素分數跟ADL、IADL失能的情形，以推估社區老人對於物理治療的需要程度。
在研究結果中，所發展的EMI身體功能量表，其Cronbach Alpha為0.9662，而與MPPT的Pearson's correlation為-0.94，顯示EMI量表是信效度均高的量表。在因素分析的結果中，將18個項目刪除3個項目後進行分類，結果分成上肢與軀幹控制、下肢肌力與平衡、心肺耐力與下肢耐力三類物理治療的需要，並可解釋86.0%的總變異量。在上肢與軀幹控制、下肢肌力與平衡、心肺耐力與下肢耐力的身體功能障礙比率，分別為15%、38%、57%，以下肢肌力與平衡跟心肺耐力與下肢耐力的障礙情形較多。經過複迴歸分析的結果，顯示在有中風、有心臟病、無工作、有下肢疼痛、有認知功能障礙、年齡較大、無運動、有痛風或關節炎或風濕、有憂鬱情形都會影響身體功能的表現。在物理治療的需要上，以下肢肌力與平衡、心肺耐力與下肢耐力的比率較高，推估可能會有59%的社區老人在未來或是現在的生活中有需要接受物理治療。
從本研究的結果，了解到較容易有身體功能障礙的情形，希望有關單位可針對危險性較高的對象，進行相關的預防措施與宣導，並設計相關的活動以教導老人如何減緩身功能衰退。針對物理治療需要比率較高的項目，提供確切的治療，希望有關單位可進一步評估社區物理治療的需要，以規劃適合老人的治療模式。希望經過研究的分析，可針對老人身體功能的表現，結合政府、社區的力量，推行健康促進政策以減少身體功能衰退的情形，讓每位老人都有一個充實愉快的生活，能達到成功老化的境界。

關鍵字

身體功能 ； 老人活動指標 ； 物理治療 ； 老人

並列摘要

The purpose of the study was to develop a physical function instrument (Elderly Mobility Index, EMI) for elderly among the community. The instrumental assessment was used to understand physical function of elderly among the community. For the elderly with physical disabilities, this study examined the need of physical therapy and analyzed factors that affected physical function in order to understand the status for the need of physical therapy among the communities’ elderly.
The study was based on the study of “ successful aging for elderly in Taiwan” in 2004. The participants consisted of elders who live in Miaoli city and aged 65 years or older, selected by a three stage stratified method. We invited 720 elders to join the study and completed 584 interviews with completion rate of 81.1%.We used factor analysis for a developmental scale for classification. Independence T test, ANOVA and multiple regression analysis were used to examine factors related to physical function. Pearson correlation was used to explore the relationship among ADL, IADL and EMI.
The results of the study included (1) The Cronbach Alpha of EMI is 0.9662 and Pearson correlation coefficients of EMI with MPPT is -0.94 which indicated that EMI is an instrument of high reliability and validity. (2) By factor analysis, EMI items were classified into upper limb and trunk control、lower limb strength and balance、lower limb endurance and cardiovascular endurance for the need of physical therapy. (3) the disability rate of any item in upper limb and trunk control、lower limb strength and balance、lower limb endurance and cardiovascular endurance were 15%, 38% and 57%. (4) The individuals who had of stroke, cardiac disease, lower limb pain, gout, arthritis, depression, cognitive impairment, lack of exercise, unemployed had poor physical function. (5) 59% of community-dwelling elders were estimated to need physical therapy in the future or now, especially lower limb strength and balance, lower limb endurance and cardiovascular endurance.
We suggest promoting to preventive maneuvers and design activities for high risk sectors of the elderly population in order to slow down the deterioration of physical function. We also suggest providing appropriate physical therapy of highly disabled physical functions for the community elders. Through this study, we hope to that the health promotion policy could slow down physical disability and allow the community elderly to enjoy an enriched life and achieve successful aging.

並列關鍵字

physical function ； Elderly Mobility Index ； physical therapy ； elderly

參考文獻

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