住院對中高齡者日常生活功能表現與復健介入影響

Functional Trajectories of Middle Aged and Elderly Patients Admitted to Hospital and the Effect of Rehabilitation Treatment

本研究初探中高齡者住院前、住院後與接受復健，到出院時在各項日常生活功能的影響。收案自花蓮某醫院年齡55歲以上，認知配合，住院巴氏量表(Barthel Index, BI)≦90分有照會復健之內科病人，住院期間每次1小時復健介入。住院前2週(T0),住院後(T1)與出院前(T2)評估BI。共80位病人（男54%）平均70±11.6歲完成評估。T0 BI平均87.6±21.3分，T1為33.8±25.9分，整體下降61%，以樓梯、洗澡降幅逾90%，如廁與行走約70%次之。平均住院24.9±12.9天，復健7.3±3.7次，T2 BI平均52.5±28.7分，相較T2進步21%，以行走、轉位與穿脫衣服改善最明顯、達30%，唯對比T0降幅仍有40%。研究結論：中高齡者住院後在樓梯、洗澡、如廁與行走功能相較T0衰退最顯著。出院時以轉位、行走及穿脫衣服進步最多，但洗澡、如廁、樓梯活動仍顯著衰退。

This study aims to explore the trajectories of Activities of Daily Living (ADLs) in middle-older patients on admission, during rehabilitation, and at discharge, comparing them to their pre-hospitalization status. Subjects aged 55 years and older, with intact cognition, a Barthel Index (BI) score of 90 points or less, and referred to rehabilitation treatment, were recruited from the internal medical wards of a hospital in Hualien. All subjects received a minimum of 60 minutes of rehabilitation intervention during their hospital stay and were assessed using the BI at three time points: two weeks before hospitalization (T0), after hospitalization (T1), and at discharge (T2). A total of 80 patients who met the criteria (54% male; mean age of 70±11.6 years) completed the three-time points evaluations. At T0, these patients had a mean BI score of 87.6±21.3, which decreased to 33.8±25.9 at T1, representing a 61% overall decrease. This decrease was particularly pronounced in stair activity and bathing, followed by toileting and moving ability, with reductions of over 90% and 70%, respectively. The mean duration of hospital stay among these patients was 24.9±12.9 days, and they received a mean of 7.3±3.7 rehabilitation interventions during their hospital stay. Compared to T1, T2 presented a mean score of 52.5±28.7 points, indicating a 21% improvement in the BI, with significant gains, particularly in moving, transposition, and dressing, showing a 30% improvement. However, there was still a 40% decline compared to T0. In conclusion, the middle-older patients presented a significant decline in BI after hospitalization, particularly in stair activity, bathing, toileting, and moving. After rehabilitation intervention during the hospital stay, they showed a significant improvement of 21% in the BI at discharge, especially in transposition, walking, and dressing, there still existed a significant decline in bathing, toileting, and stairs at discharge.