機構照護新思維－台灣長照機構推動生活自立支援對能力回復與生活品質之成效探討

Innovations in Institutional Care- The Effect of Reablement in Long-term Care Facilities in Taiwan

目標

探討台灣機構實施生活自立支援介入方式及成效與其相關影響因素。

方法

採用單組前後測，以24家長照機構中符合65歲以上，有約束、使用尿布或臥床其中之一狀態者為對象。於基期與介入第六個月蒐集數據，以巴氏量表(ADL)、工具性日常生活活動能力(IADL)、簡易智能量表(MMSE)、老人憂鬱量表(GDS-15)、歐洲生活品質(EQ-5D)、社會支持量表(ISSI)評估成效。期間另有督導表紀錄照顧計劃。最終收案人數期初310人、後測210人。

結果

介入後個案日常生活活動能力、工具性日常生活活動能力、憂鬱情形、社會支持、自覺健康相關生活品質皆顯著改善，並可維持生活品質整體指標與認知功能；多數成效受社會支持影響。

結論

自立支援可維持或改善住民身心功能，但在實施前應加強與家屬的溝通，並著重於機構人員提供的社會支持，提升生活自立支援的落實程度與效益。

 

Purpose

The aim of this study was to describe and analyze how reablement, an intervention emphasizing autonomy, was implemented in long-term care facilities in Taiwan and identified residents’ outcomes and factors that affect them.

Research Design and Methods
One-group pretest-posttest design were adopted in 24 long-term care facilities in this study, using a sample of 310 participants at baseline (T0), and 210 participants at 6 months (T1). Participants were those residents aged 65 and over, meeting at least one of the conditions of being constrained, using diapers, or bedridden. During the 6 month follow-up period, their physical and mental function, social support were measured using ADLs, IADLs, MMSE, GDS-15, EQ-5D and ISSI at baseline (T0) and 6 months (T1). There are also the intervention notes for recording the caregiving plans that supervisors suggest for participants in the duration.

In data analyses, the mean difference and Mixed effect model were analyzed to determine the effects of the interventions by examining the outcome variables, while controlling potential confounding of the demographic variables.

Results

The sample was 40.6% male, with a mean age of 81.27. Most of the participants had good family support. However, participants with better family support were also more likely to drop out the intervention. The improvement of residents’ outcomes was found, such as ADLs, IADLs, GDS-15, EQ-5D and ISSI were statically significant at the 6 months. The change in social support within facility staff and participants is a crucial factor that affects the health outcomes.

Conclusions

The positive effect of reablement in resident outcomes were significant in physical function and social support, and it helps also maintain mental function. And all the results indicate that sufficient support and communication between participant, family and staff in facilities were the key factor leading to a successful reablement intervention program.