85 住院老人功能衰退的危險因素及照護 黃惠子陳清惠 * 隨著老年人口比率的攀升, 老人因罹患慢性疾病而住院的比率也逐漸提升, 目前住院病患中有高 達 27% 為 65 歲以上老年人 研究顯示, 有高達 30% 至 60% 的老年住院患者, 出院後出現功能衰 退的現象 本文主要透過文獻發現住院老人有六 項功能衰退的確認危險因子, 包括高齡 活動功 能障礙 (ADL IADL 上下肢活動受限 活動能 力差 失能 ) 認知障礙 疾病 ( 診斷 憂鬱 尿失禁 ) 住院 ( 住院天數 先前住院次數 ) 以及 人口學特性 ( 體重過重 低收入 機構住民 ) 在功能衰退的照護措施上, 可以運用跨專業老人 照護模式 營造親善老人醫療環境以及施行運動 計畫等 由於健康照護成本日趨高昂, 健康照護 者若能即時掌握住院老人發生功能衰退的危險特 性, 並早期介入與防範, 以期降低失能的危險 住院老人 功能衰退 危險因子 96 12 23410.2% 2008 Inouye et al., 1998 2007 65 27% 2008 4 Cochran, 2005 30% 60% Hoogerduijn, Schuurmans, Duijnstee, de Rooij, & Grypdonck, 2007 2004 Hoogerduijn et al., 2007 McCusker Kakuma Abrahamowicz 2002 25% Hanson Mahoney Palta 1999 50% 3 1996 activity of daily living, ADL Katz Ford Moskowitz 1963Katz index of ADLHoogerduijn et al., 2007 Barthel Index Functional Independence Measure, FIM Instrument of Activity of Daily Living, IADL Physical Selfmaintaining Scale Karnosky Scale 1996 Katz Index * 97 3 8 97 10 13 70101 06 2353535 5834
86 Predictors of Functional Decline in Elderly 2004 1996 Wallace & Shelkey, 2008 Lawton Brody 1969 IADL IADL Ward, Jagger, & Harper, 1998 IADL ADL IADL 1996 Ward et al., 19982004 IADL ADL ADL ADLADL Hoogerduijn et al., 2007 Wallace & Shelkey, 20082004 743 ADL IADL McCusker et al., 2002 2004 437 FIM Wu Leu Li 1999 ADL ADL2004 83 800 IADL ADL 1976 Medline CINAHL Cochrane Pub-Med Miller Weissert 2000 65 1985 1998 78 10 McCusker 2002 1976 1998 33 Hoogerduijn 2007 1990 2005 10 6
87 Miller & Weissert 2000 McCusker et al. 2002 Hoogerduijn et al. 2007 1. 2. 1985 1998 13 1976 1998 22 1990 2005 15 1. 2. 65 3. 1985 1. 2. 60 1. 2. 3. 1. 2. 50 1. 2. 3. 60 4. 5. 6. 7. 8. 1. 2. 3. 78 33 10 1. 2. 3. 4. 1. 2. ADL 3. IADL 4. 5. 6. 7. 8. 9. 10. 1. 2. ADL, IADL 3. 4. 5. 1. 2. ADL 3. IADL 4. 5. 6. length of stay, LOS ADL IADL World Health Organization, WHO well-beinghickman, Newton, Hal-
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90 Predictors of Functional Decline in Elderly Predictors of Functional Decline and Care for the Hospitalized Elderly Hui-Tzu Huang Ching-Huey Chen * Abstract: The number of elderly patients in hospitals rises as a country s population ages. In Taiwan, roughly 27% of hospitalized patients are elderly. Previous studies have reported that 30% to 60% of hospitalized elderly patient experienced functional decline following discharge. This article reviews references on the predictors of functional decline in hospitalized elderly. Six predictors are summarized, including, senility, daily activity disturbance (activity of daily living, preadmission disability in instrument activity of daily life), cognitive impairment, diseases (diagnosis, depression, incontinence), and hospitalization (length of hospital stay, prior hospital utilization, and demographic characteristics [e.g., high body mass, low income, institutional resident]). Nursing interventions that have been shown to help moderate functional decline in elderly patients include the multidiscipline care model, creating an elder-friendly environment, and facilitating exercise programs. As healthcare costs are so high, the need to decrease negative outcomes in personal health is a pressing issue. Thus, identifying hospitalized elderly at risk and providing intervention to prevent disabilities is an important mission of healthcare providers. Key Words: hospitalized elderly, functional decline, predictors. RN, MSN, Instructor, Department of Nursing, Chung Hwa University of Medical Technology & Doctoral Student, Graduate Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University; *RN, PhD, Associate Professor, Department of Nursing, College of Medicine, National Cheng Kung University. Received: March 8, 2008 Revised: May 6, 2008 Accepted: October 13, 2008 Address correspondence to: Ching-Huey Chen, No. 1, Tahsueh Rd., Tainan 70101, Taiwan, ROC. Tel: +886 (6) 2353535 ext. 5834; E-mail: sugar@mail.ncku.edu.tw