護理之家與社區老人睡眠品質及預測因子之比較

Comparisons of Sleep Quality and Predictors between Nursing Home Residents and Community Dwelling Elderly

背景：睡眠障礙是老年人常見的問題，對其生活品質、情緒、認知及生理功能會造成負面的影響。目前並無研究針對社區和機構老人的睡眠品質進行探索與比較。目的：比較護理之家與社區老人睡眠品質及其預測因子之差異。方法：本研究採橫斷式調查法，資料收集時間自2013年5月至9月止，符合收案條件共124位（護理之家30人；社區94人）參與研究。使用匹茲堡睡眠量表、七日身體活動回憶量表、老人憂鬱量表收集資料。結果：護理之家老人的睡眠品質不佳的比率（93.3％）顯著高於社區老人（47.9％），且在主觀睡眠品質、睡眠潛伏期、睡眠效率、使用安眠藥及日間功能障礙的平均得分均顯著高於社區老人。護理之家老人睡眠品質的預測因子為服用鎮靜安眠藥及性別，解釋量可達37.6％。社區老人睡眠品質的預測因子為服用鎮靜安眠藥、每週相對輕度活動量、環境光線干擾度、罹患慢性病總數、干擾睡眠症狀、服用支氣管用藥、噪音干擾度等七個變項，整體解釋量可達54.7％。結論：護理之家老人的睡眠品質較社區老人差，預測因子各自不同，服用鎮靜安眠藥是共同且最重要的預測因子。護理人員宜針對社區和護理之家老人睡眠品質的預測因子提供適當的衛教和指導，以改善其生活品質。

Background: Sleep disorders are common problems in the elderly and can have a negative impact on their quality of life, mood, cognition and physiological function. Currently there is no research to explore and compare the sleep quality of the elderly in the community and nursing home. Purpose: The purpose of this study is to compare the sleep quality and its predictors between nursing home residents and community dwelling elderly. Method: This research is a cross-sectional study. Subjects who met the selection criteria were recruited in the study from May to September 2013. In total, 124 subjects (nursing home n=30; community dwelling n=94) participated in the study. Three instruments including Pittsburgh Sleep Quality Index, Seven-day Physical Activity Recall, and Geriatric Depression Scale Short Form were used for data collection. Results: The proportion of poor sleep quality of elderly people in nursing homes (93.3%) was significantly higher than that in the community (47.9%). The subjects' average scores in overall sleep quality, sleep latency, sleep efficiency, sedations taking and day dysfunction due to sleepiness in nursing home were significantly higher than in community dwellings. Both taking sedations for sleep and gender explain 37.6% of total sleep quality predictor variance in nursing home residents. Seven predictors, including taking sedations for sleep, relatively low amount of light physical activity, disturbance by light, the total number of chronic diseases suffered, sleep disturbance symptoms, and taking bronchial medicine, explain 54.7% of total sleep quality variance in community dwellings elderly. Conclusion: The quality of sleep in elderly people in nursing homes is worse than that in the community. Although the predictors of sleep quality are roughly different, taking sedative sleeping pills is the common and most important predictor. Nursing staff should provide appropriate education and guidance according to the predictors of sleep quality in the community and nursing homes to improve their quality of life.