陽光照射對老人健康之影響

The Impact of Sunlight Exposure on the Health of Older Adults

10.6224/JN.63.4.116

林姿佳(Tzu-Chia Lin)；廖彥琦(Yen-Chi Liao)

陽光照射 ； 老人 ； 維生素D ； sunlight exposure ； elderly ； vitamin D

護理雜誌

63卷4期（2016 / 08 / 01）

116 - 122

繁體中文

適度的陽光照射不僅有助於人體維生素D的生成，對改善骨骼健康、情緒認知有正面的影響外，更可調節褪黑激素的分泌而調控人體生理時鐘，有益於改善老人的睡眠品質，增加身體活動和社交的參與度。但長時間曝露在陽光下，對人體皮膚、眼睛及免疫系統的傷害也是不可忽視的。不過因許多研究均顯示，老人接觸陽光的時間普遍不足，特別是機構老人的活動型態多以室內為主，清醒時間多是坐著發呆或是坐在電視前打瞌睡。再加上健康因素、環境設計、個人喜好與機構活動設計，都會使得機構老人接觸陽光的時間少於一般可自我照顧的長者。因此建議除了從飲食及營養補充品中適當補充維生素D外，也可以在做好適當的防曬措施下，讓老人每週進行戶外活動至少五次，每天20-30分鐘。長期照護機構在硬體設備亦建議能增加老人接觸陽光的方便性與可近性外，也可將部分的活動設計在戶外舉行，讓機構的老人有適當接觸陽光的機會。

Appropriate exposure to sunlight not only contributes to the production of vitamin D, which has been associated with enhanced bone health, mood, and cognitive functions, but also regulates the secretion of melatonin, which has been associated with the mediation of circadian rhythms, improved sleep quality, and optimized physical and social activity in the elderly. However, damage to the skin, eyes, and immune system has also been widely associated with long-term exposure to sunlight. Several studies have shown that many elderly, especially those that reside in institutions, do not receive sufficient sunlight exposure. Institutionalized elderly tend to participate in indoor activities and spend significant periods of time alone and asleep in front of the television. Furthermore, factors such as poor health, environmental design, indoor/outdoor preference, and activity design may impact the access of institutionalized elderly to sunlight more than their non-institutionalized peers. Therefore, we suggest that in addition to obtaining sufficient levels of vitamin D from their diet and from supplements, the elderly should perform outdoor activities for 20-30 minutes a day for five days each week. Furthermore, we suggest that the environment of the care facility should be made be more accessible and that some activities should be held outdoors.

1. World Health Organization. (n.d.). Ultraviolet radiation and the INTERSUN programme. Retrieved from http://www.who.int/uv/faq/en/
2. Health Promotion Board. (2012). Calcium-For greater bone strength. Retrieved from http://www.hpb.gov.sg/HOPPortal/health-article/2834
3. Cancer Council of Australia. (2007). Position statement-Sun exposure and vitamin D-risks and benefits. Retrieved from http://www.cancer.org.au/content/pdf/CancerControlPolicy/PositionStatements/PSRisksBenefitsSunExposure03May07.pdf
4. United States Environment Protection Agency. (2015). Action steps for sun safety. Retrieved from http://www.epa.gov/sunsafety/action-steps-sun-safety
5. 行政院環境保護署（2016年2月19日）．紫外線相關資訊．取自http://taqm.epa.gov.tw/taqm/tw/b12071.aspx [Environmental Protection Administration Executive Yuan. (2016, February). Information on ultraviolet light. Retrieved from http://taqm.epa.gov.tw/taqm/tw/b12071.aspx]
6. Alessi, C. A.,Martin, J. L.,Webber, A. P.,Kim, E. C.,Harker, J. O.,Josephson, K. R.(2005).Randomized, controlled trial of a nonpharmacological intervention to improve abnormal sleep/wake patterns in nursing home residents.Journal of the American Geriatrics Society,53(5),803-810.
7. Baggerly, C. A.,Cuomo, R. E.,French, C. B.,Garland, C. F.,Gorham, E. D.,Grant, W. B.,Wunsch, A.(2015).Sunlight and vitamin D: Necessary for public health.Journal of the American College of Nutrition,34(4),359-365.
8. Balion, C.,Griffith, L. E.,Strifler, L.,Henderson, M.,Patterson, C.,Heckman, G.,Raina, P.(2012).Vitamin D, cognition, and dementia: A systematic review and metaanalysis.Neurology,79(13),1397-1405.
9. Barysch, M. J.,Hofbauer, G. F.,Dummer, R.(2010).Vitamin D, ultraviolet exposure, and skin cancer in the elderly.Gerontology,56(4),410-413.
10. Broke, K.,Wilkinson, M.,Cook, R.,Lee, S.,Bermingham, M.(2004).Associations with vitamin D deficiency in "at risk" Australians.The Journal of Steroid Biochemistry and Molecular Biology,89-90,581-588.
11. Brown, M. A.,Goldstein-Shirley, J.,Robinson, J.,Casey, S.(2001).The effects of a multi-modal intervention trial of light, exercise, and vitamins on women's mood.Women & Health,34(3),93-112.
12. Coon, J. T.,Boddy, K.,Stein, K.,Whear, R.,Barton, J.,Depledge, M. H.(2011).Does participating in physical activity in outdoor natural environments have a greater effect on physical and mental wellbeing than physical activity indoors? A systematic review.Environmental Science & Technology,45(5),1761-1772.
13. Durvasula, S.,Kok, C.,Sambrook, P. N.,Cumming, R. G.,Lord, S. R.,March, L. M.,Cameron, I. D.(2010).Sunlight and health: Attitudes of older people living in intermediate care facilities in southern Australia.Archives of Gerontology and Geriatrics,51(3),e94-e99.
14. Durvasula, S.,Mason, R. S.,Kok, C.,Macara, M.,Parmenter, T. R.,Cameron, I. D.(2015).Outdoor areas of Australian residential aged care facilities do not facilitate appropriate sun exposure.Australian Health Review,39(4),406-410.
15. Durvasula, S.,Sambrook, P. N.,Cameron, I. D.(2012).Factors influencing adherence with therapeutic sunlight exposure in older people in intermediate care facilities.Archives of Gerontology and Geriatrics,54(2),e234-e241.
16. Huang, E. J.-C.,Wu, S. H.,Lai, C. H.,Kuo, C. N.,Wu, P. L.,Chen, C. L.,Wu, P. C.(2014).Prevalence and risk factors for age-related macular degeneration in the elderly Chinese population in south-western Taiwan: The Puzih eye study.Eye,28(6),705-714.
17. Kim, J. H.,Chang, J. H.,Kim, D. Y.,Kang, J. W.(2014).Association between self-reported sleep duration and serum vitamin D level in elderly Korean adults.Journal of the American Geriatrics Society,62(12),2327-2332.
18. Nilson, F.,Moniruzzaman, S.,Andersson, R.(2014).A comparison of hip fracture incidence rates among elderly in Sweden by latitude and sunlight exposure.Scandinavian Journal of Public Health,42(2),201-206.
19. Penckofer, S.,Kouba, J.,Byrn, M.,Ferrans, C. E.(2010).Vitamin D and depression: Where is all the sunshine?.Issues in Mental Health Nursing,31(6),385-393.
20. Roelandts, R.(2002).The history of phototherapy: Something new under the sun?.Journal of the American Academy of Dermatology,46(6),926-930.
21. Sambrook, P. N.,Cameron, I. D.,Chen, J. S.,Cumming, R. G.,Durvasula, S.,Herrmann, M.,Simpson, J. M.(2012).Does increased sunlight exposure work as a strategy to improve vitamin D status in the elderly: A cluster randomized controlled trial.Osteoporosis International,23(2),615-624.
22. Skjerve, A.,Bjorvatn, B.,Holsten, F.(2004).Light therapy for behavioural and psychological symptoms of dementia.International Journal of Geriatric Psychiatry,19(6),516-522.
23. Toffanello, E. D.,Coin, A.,Perissinotto, E.,Zambon, S.,Sarti, S.,Veronese, N.,Sergi, G.(2014).Vitamin D deficiency predicts cognitive decline in older men and women: The Pro. V. A. study.Neurology,83(24),2292-2298.
24. Webb, A. R.,Engelsen, O.(2006).Calculated ultraviolet exposure levels for a healthy vitamin D status.Photochemistry and Photobiology,82(6),1697-1703.
25. Zhu, D.,Liu, G. Y.,Lv, Z.,Wen, S. R.,Bi, S.,Wang, W. Z.(2014).Inverse associations of outdoor activity and vitamin D intake with the risk of Parkinson's disease.Journal of Zhejiang University-SCIENCE B (Biomedicine & Biotechnology),15(10),923-927.
26. 宋永魁編(2015)。2015 台灣成人骨質疏鬆症防治之共識及指引。台北市=Taipei City:中華民國骨質疏鬆症學會=The Taiwanese Osteoporosis Association。
27. 杜柏村、徐國雄、蔡尚峰(2012)。維生素D與慢性腎臟病。腎臟與透析，24(3)，161-167。
28. 富柏英、呂惠霞、張觀如(2007)。護理之家住民活動計劃改善專案。長期照護雜誌，11(4)，381-391。
29. 衛生福利部國民健康署(2013)。骨質疏鬆症臨床治療指引。台北市=Taipei City:作者=Author。

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