住院老人便秘之危險因素

Risk Factors of Constipation in the Hospitalized Elderly

便秘是住院老人常見的臨床問題。疾病、老化及用藥均易使住院老人發生便秘，而國內文獻卻少有人探究。本研究目的是探討住院老人人口學變項、健康狀況及住院期間經歷的便秘危險因素，與發生便秘的關係。本研究採縱貫式觀察，在台北市某醫學中心六個內外科病房篩選出152位65歲（含）以上，無慢性便秘且符合收案條件的老人，於住院後每天收集排便狀況的資料，並各於第四天及發生便秘時收集便秘危險因素之相關變項的資料。結果顯示：無便秘史的老人於住院後有50位(32.9%)發生便秘，其中超過三天以上未解便者有38位(25.0 %)，而解硬便者有12位(7.9 %)。Logistic多變項迴歸分析結果為，個案攝取食物纖維量少於6公克（含）發生便秘的機率是多於6公克者的6.21倍；完全臥床者發生便秘機率是可獨立活動者的3.47倍。而其它如：性別、年齡、疾病數目和種類、攝水量、使用非瀉劑藥物種類及致便秘藥物等變項，皆未達統計上的差異。透過本研究結果，可幫助醫護人員對住院老人便秘問題有更深入的瞭解，且能事先篩選發生便秘的高危險群，給予妥善預防和適當處置，以增進住院老人之生活品質。

Constipation is a common problem among hospitalized elderly patients. To know what causes the elderly particularly at risk of becoming constipated is important for health care providers. By reviewing references on this topic, investigation related to constipation has been relatively sparse and the findings are inconsistent. Hence, the objectives of this study were to investigate the relationships between the demographic characteristics, health status, diet, activities, medications and the occurrence of constipation in the hospitalized elderly. We used longitudinal observation to investigate 152 patients who did not have a history of constipation, aged 65 years and over in six wards of a tertiary medical center in Taipei. The data of bowel movement was collected during hospitalization everyday. On the 4th day of admission and the day of identifying constipation, the researcher collected data on risk factors of bowel movement. The results of this study showed that: 1. Fifty subjects (32.9%) in the sample developed constipation during hospitalization, among them, thirty-eight subjects (25.0%) did not have a bowel movement for more than three days, and twelve subjects (7.9%) passed hard stools. 2. A stepwise logistic regression model showed that the hospitalized elderly who assimilated 6g or less of dietary fiber were 6.21 times more likely to develop constipation than those who assimilated more than 6g of dietary fiber. Bedridden elderly were 3.47 times more likely to suffer from constipation than those who ambulated independently. Other variables, for example; sex, age, number and category of diseases, fluid intake, non-laxatives drugs, and constipation inducing drugs etc. were not shown to be statistically significant. The findings of this study may help nurses to understand the problem of constipation among the hospitalized elderly, screen and detect the high-risk groups early to prevent the occurrence of constipation, and provide appropriate intervention and implement professional nursing in order to increase the quality of life among hospitalized elderly patients.