機構老人之睡眠品質及其相關因素

Quality of Sleep and Its Associated Factors in the Institutionalized Elderly

本研究之目的是探討機構老人的睡眠品質狀況及影響其睡眠品質的相關因素。本研究採描述性、相關性之研究，立意取樣台北縣市四家公私立的安養機構，以系統取樣共收集205位個案，個案均符合下列條件：（1）年滿65歲或以上；（2）沒有瞻妄、癡呆及精神病的問題；（3）能以國、台語溝通；（4）入住安養機構在6個月以上者。以睡眠品質訪談表（PSQI）評量其睡眠品質，以巴氏量表（Barthel index）測量日常生活功能，以流行病學研究中心憂鬱量表（CES-D）測其憂鬱程度。結果顯示研究對象中睡眠品質良好者（PSQI≦5分）有30.7%，而睡眠品質差者（PSQI＞5）分佔69.3%，睡眠品質平均得分9.53±4.89，59%對睡眠品質感到不滿意，以睡眠潛伏期增長而導致難以入睡最嚴重。而慢性病總數、日常生活功能狀態、憂鬱與而睡眠品質呈顯著相關，可以解釋睡眠品質變異量的36.8%，其中以「憂鬱」的解釋力最高，本研究結果顯示憂鬱對睡眠品質是一個非常重要 預測因子。以Logistic多變項迴歸分析發現日常生活功能狀態有障礙者、有憂鬱傾向者，罹患﹥種慢性病，其發生睡眠品質差的機率分別是日常生活功能獨立者、無憂鬱傾向者、罹患0.1種慢性病的2.35、10.00、14.14倍。透過本研究結果可以提供機構的醫護人員區辨具備那些特質者易成為睡眠品質不良的高危險群，給予合適的預防措施及處置，以增進機構老人的生活品質。

The purpose of this study was to investigate the sleep quality of elderly residents of institutes and the related influence factors. The retrospective and descriptive method was utilized in this study. Two hundred and five subjects were selected from the residents of residential care institutes in 4 public or private residential care institutes in Taipei by the systematic random sampling. All subjects must fit in following condition: (1) over 65 years old; (2) no delirium, dementia or psychosis; (3)speaking Mandarin or Taiwanese; (4)stay in institutes over six months. Using PSQI to measure sleep quality, Barthel index to measure activity of daily living (ADL), and CES-D to measure depression, the average PSQI global score of total subjects was 9.53±4.89. There were 63(30.7%) subjects in good sleep quality (PSQI≦5), while the other 142(69.3%) were in poor sleep quality (PSQI＞5). The most serious problem is the increasing sleep latency. There was 59% subjects dissatisfied in self-perceived quality of sleep. There was significant correlation among the number of chronic disease, the ADL, depression and sleep quality, and could explain36.8% variation of sleep is quality. This study show the subjects with defect of ADL, their odd ratio of poor quality of sleep is 2.35 times to the normal. The 10.11 times of subjects with the trend to depression compared with those didn't. the 4.14times of subjects with chronic diseases ﹥1type compared with 0-1type. The high-risk group of poor quality of sleep is the subject with defect of ADL、trend to depression and predictor of sleep quality. The study finding can help health care personnel to identify suffer from poor sleep quality, in order to offer appropriate prevention and management, and improve the life quality of elderly residents of institutes.