影響住院高齡者返家後行走功能恢復因素之探討

Factors Influencing the Recovery of Walking Ability in Older Adults After Hospital Discharge

背景：住院常導致高齡者發生身體功能衰退，其中行走功能是最先發生衰退的身體功能，且行走功能衰退會影響高齡者返家後日常生活活動的獨立性。目的：探討影響住院高齡者返家後行走功能恢復之因素。方法：採縱貫式研究設計，於南部某醫學中心召募出院時行走功能衰退並預定返家照護之65歲以上高齡者。出院時資料收集包含：基本特性、查爾森共病症指標、修正版凱茲日常生活量表之行走功能、迷你營養評估量表、簡易智能評估量表與住院期間是否下床活動。返家後三個月追蹤資料包括：修正版凱茲日常生活量表之行走功能、有無規律運動習慣，及有無接受復健及社會支持量表。結果：共收集78位高齡者，75.64％高齡者於返家後三個月有恢復行走功能。高齡者營養狀態、認知功能、返家後規律運動習慣與行走功能恢復呈顯著相關。多元羅吉斯迴歸分析結果發現，住院高齡者返家後有規律運動習慣者較無規律運動習慣者，其行走功能恢復勝算比為10.212（p＝.004）。結論／實務應用：住院高齡者除急性問題治療外，應同時進行營養、認知與活動功能評估與照護。於出院護理計畫更應宣導返家後規律運動之重要性，以促進高齡者行走功能恢復，進而維護高齡者自主生活能力。

Background: Functional decline is a common complication in hospitalized older adults, and decline in the ability to walk is often the first change in physical functioning in this population. Decline in walking ability leads to a loss of independence in the activities of daily living in older adults after discharge from the hospital. Purpose: To explore the factors associated with the recovery of walking ability in older adults after discharge from the hospital. Methods: This study used a longitudinal research design. Potential participants were recruited from a tertiary medical center in southern Taiwan. Patients were eligible for inclusion if they were at least 65 years old and were affected by a decline in walking ability at discharge. The data collected at discharge included: demographic information, Charlson Comorbidity Index, Modified Katz Index of Independence in Activities of Daily Living (walking item), Mini Nutritional Assessment, Mini-Mental State Examination, and ambulation during hospital stay. The follow-up data collected at three months after discharge included: Modified Katz Index of Independence in Activities of Daily Living (walking item), exercise habit, rehabilitation, and social support. Results: A total of 78 older adults were enrolled as participants. Three-quarters (75.64%) of the participants had regained their ability to walk at three months after discharge. Moreover, nutritional status, cognitive function, and exercise habit were significantly associated with the recovery of walking ability. The results of multiple logistic regression analysis showed having an exercise habit to be significantly associated with the recovery of walking ability at three months after discharge (OR = 10.212, p = .004). Conclusions/Implications for Practice: In addition to treating the acute medical issues of older patients, healthcare professionals should screen and provide them with appropriate nutritional, cognitive, and physical care plans. Moreover, emphasizing the importance of an exercise habit in nursing discharge plans is also important. This effort may help older adults recover their walking ability and maintain their independence.