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    Please use this identifier to cite or link to this item: http://asiair.asia.edu.tw/ir/handle/310904400/110979


    Title: 活動參與對機構住民臨終前臥床天數的影響–一個護理之家的觀察性研究
    Authors: 賴清豐
    Contributors: 健康產業管理學系長期照護組碩士在職專班
    Keywords: 輔療、運動、臨終前臥床天數、non-pharmaceutical therapy、exercise、bedridden days
    Date: 2018
    Issue Date: 2018-06-14 16:08:21 (UTC+8)
    Publisher: 亞洲大學
    Abstract: 隨著老年人口增加,慢性疾病及功能障礙人口也急遽上升,繼而讓醫療服務與長期照護需求也大幅增加。衛生福利部2015年統計,全國失能人口為76萬人,預估2031年失能人口將達120萬人,少子化問題亦造成因人口老化所衍生的扶養及經濟負擔問題,為減低下一代的負擔,應努力維持成功老化及活躍老化。因此如果可以提升民眾健康或減少民眾失能或減少臨終前臥床天數當可減少社會資源耗用。因此本研究欲瞭解活動參與對機構住民臨終前臥床天數的影響,將釐清護理之家住民個人屬性與活動參與的相關性,進而探討活動對住民臨終前臥床天數的影響。本研究活動包括輔療、復健與運動等三類活動,運用護理之家已往生住民個案資料進行資料分析。
    本研究採回溯縱貫性次級資料研究方法,收案時間自2012年3月1日至2016年5月31日止。本研究最後收案對象為53位住民,平均臨終前臥床天數為151天,結果發現ADL平均值越高,臨終前臥床天數越少(P<0.05),經常參加運動的住民臨終前平均臥床天數最低(P=0.021)。回歸分析中發現在76歲到85歲之間,隨著年齡增加,臨終前臥床天數跟著增加(P=0.007),隨著經常參加運動次數增加(P=0.032)、參加多項運動次數增加(P=0.001)及ADL(P=0.012)分數增加,則臨終前臥床天數跟著減少。存活分析發現有65%機率臥床者參加多項運動組別,臨終前臥床天數為10天,有70%機率臥床者經常參加運動組別,臨終前臥床天數為20天,70%機率臥床者偶爾參加運動的,臨終前臥床天數為35天,65%機率臥床者經常參加輔療活動組別,臨終前臥床天數為45天。再進一步追蹤發現影響活動參與的,單身或喪偶有參與運動的老人是已婚或同居老人的25倍(OR=0.04,P=0.05)。臨終前臥床天數30天以下參加單項運動的住民是臨終前臥床天數90天以上的100倍(OR=0.01,P=0.01)。
    由此結果可以發現,以同樣是結束死亡的時間點往前觀察,臨終前臥床天數少的住民,因為參加了更多的運動或參與更多項的活動,在臨終臥床前多了比臥床天數長的住民獲得了更多對身心有益且有好的舒適愉快和生活品質的時間,對於生命結束前,可以說是人生中有一段美好的終點。

    Since the elderly population increases rapidly, there is a rise in number of people with chronic diseases and dysfunction. The demand for medical services and long-term care has also increased dramatically. Therefore, we have to do many efforts to let people maintain in the status of successful aging and active aging in order to reduce the burden of people in next generation. If we can improve people's health or reduce disability or reduce the days of bedridden before death, we can reduce the consumption of social resources. This study would like to understand the impact of activities participation on the bedridden days before death for institutional residents and detect related variables of the nursing home residents’ personal attributes to the participation of the activities.
    This study adopted the retrospective longitudinal approach with secondary data analysis and collected data from March 1, 2012 to May 31, 2016. This study recruited 53 residents who died in a nursing home and the average days of the bedridden before death was 151 days. The higher the average of ADL was, the less the days of bedridden before death is (P <0.05). The residents who regularly participated in sport exercise had the less of the days of bedridden (P = 0.021). The model of regression analysis was found the residents with the age between 76 and 85 years old, while their age increased and the days of bedridden before death increase, too (P = 0.007). And the bedridden days before death decreases, while the regular exercises increase (P=0.032), using more kinds of exercise increases (P=0.001) and ADL scores increase (P=0.012). This study results appears that 65% of residents participated in the group of more kinds of exercises, the bedridden days before death were 10 days; 65% of residents participated in the group of more frequency of sport exercise, the bedridden days before death were 20 days; 70% of residents participated in the group of less frequency of sport exercise, the bedridden days before death were 35 days; 65% of residents often participates in non-pharmaceutical therapy group, the bedridden days before death were 45 days. The further analysis focused on the related factors to the activities participation. The odds ratio of the single or widowed elders who participate in sport exercises was 25 times the elderly who married or living together with spouses (OR=0.04,P=0.05). The odds ratio of the group of the bedridden days less than 30 days and the residents who always participate in one exercise was 100 times the group of the bedridden days more than 90 days (OR=0.01,P=0.01).
    In conclusion, from being active to the length of being bedridden prior to death, it was revealed a lower bedridden period was dependent upon a higher rate of participation of activities and exercise. Those residents also showed to have better physical functional ability and quality of life prior to becoming bedridden. In regards to the remaining family response they reported a better memory and ending for their love one compared to the perception of a lingering traumatic extended bedridden state.
    Appears in Collections:[健康產業管理學系] 博碩士論文

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