Functional Recovery among Elderly People One Year after Hip Fracture Surgery

髖部骨折手術後老人身體功能恢復狀態一年追蹤研究

林碧珠(Pi-Chu Lin)；張蘇鈺(Su-Yu Chang)

髖部骨折 ； 老人 ； 身體功能狀態 ； hip fracture ； elderly ； functional status

The Journal of Nursing Research

12卷1期（2004 / 03 / 01）

72 - 82

英文

本研究目的在追蹤老人髖部骨折後一年在基本日常生活功能和複雜性日常生活功能之恢復情形及其影響因素。採縱貫追蹤調查法，在老人住院期間、出院前、骨折後三個月、一年以問卷收集資料。以方便取樣，樣本103 位來自台北市一家醫學中心，因跌倒造成股骨頸和股骨轉子間骨折之65 歲以上老人。研究結果顯示：髖部骨折後一年老人的基本日常生活功能 (activities of daily living, ADL) 和複雜性日常生活功能(instrumental activities of daily living, IADL) 並未回復至骨折前的水平，自出院到骨折三個月是恢復最快的時期。在ADL 方面，相較於骨折前93.2%可獨立平地行走，74.8%可獨立上下樓梯，約90%可自我照顧 (進食、如廁、穿脫衣服)，一年後只有70.9%可獨立平地行走，49.1%可自行上下樓梯，約75%可自我照顧；在IADL，骨折前73.8%可至室外走動，一年後只有58.2%可室外走動。骨折後一年ADL 恢復的預測因子為骨折前的室外走動的能力，可解釋ADL 39.7% 的總變異量，IADL 恢復的預測因子為骨折前室外走動能力、婚姻狀況和骨折前是否使用走路輔助器，可解釋IADL 56.1%的總變異量。髖部骨折造成老人身體功能的損失，建議設計以醫院為基礎的跨部門介入措施和出院準備服務。

The purposes of the present study were to follow up on the recovery of activities of daily living (ADL) and instrumental activities of daily living (IADL) one year after hip fracture in elderly people and to understand the factors that affect functional recovery. Information for this one-year study was obtained through structured interviews during the first week after admission, at discharge, three months and one year after fracture. One hundred and three elderly people over 65 years old, with femoral neck fractures and intertrochanteric fractures due to falling down were recruited from a medical center in Taipei. The results were as follows: In most cases, ADL and IADL in elderly people could not be recovered to the status before fracture in the one-year period of follow-up; the most rapid recovery period was within three months after discharge. In terms of ADL before fracture, 93.2%, 74.8%, and about 90% of patients could walk, climb stairs, and take care of themselves (feeding, toileting, dressing), respectively; however, only 70.9%, 49.1% and about 75% of patients respectively could walk, climb stairs and take care of themselves one year after hip fracture. As for IADL, 73.8% of patients could walk outdoors before fracture, but only 58.2% could walk outdoors one year after fracture. The factor on which ADL recovery within one year after hip fracture depended was the ability to walk outdoors before fracture. It explained 39.7% of total variance in ADL. As for IADL, significant predictors included doing housework, marital status and use of walking aids before fracture. These items explained 56.1% of total variance in IADL. The findings point to the functional decline of elderly people after hip fracture and suggest the importance of focusing on hospital-based multidisciplinary interventions and discharge planning.

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