住院老人功能衰退的危險因素及照護

Predictors of Functional Decline and Care for the Hospitalized Elderly

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。

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.