Depression in Older Residents with Stroke Living in Long-Term Care Facilities

長期照護機構中風老人憂鬱之探討

10.1097/jnr.0000000000000028

黃惠子(Hui-Tzu Huang)；莊宇慧(Yeu-Hui Chuang)；薛逸華(Yi-Hua Hsueh)；藺寶珍(Pao-Chen Lin)；李碧娥(Bih-O Lee)；陳清惠(Ching-Huey Chen)

日常生活功能 ； 憂鬱 ； 長期照護機構 ； 老年住民 ； 中風 ； activity of daily living ； depression ； long-term care facility ； older resident ； stroke

The Journal of Nursing Research

22卷2期（2014 / 06 / 01）

111 - 118

英文

背景　在台灣腦中風為死亡原因之第三位，中風後老人由於失能或照顧之需要而入住長期機構。中風與機構安置此兩種生活事件之衝擊，可能使中風存活者傾向憂鬱。然而目前缺乏長期照護機構中風老人憂鬱之研究。目的　探討長期照護機構中風老年住民憂鬱的相關因素。方法　採橫斷式研究，於南台灣共23家長期照護機構參與本研究，包含7間護理之家、11間養護中心及5間安養機構。以立意取樣，選取65歲以上有中風病史之住民，排除認知及溝通障礙者。資料收集包含社會人口學資料、巴氏量表及台灣老人憂鬱量表。結果　共111位中風老年住民參與本研究，結果36.9%（n = 41）之中風老年住民有憂鬱情形。憂鬱比率分別是護理之家45.7%、養護中心36.2%、安養中心22.2%。護理之家及養護機構、不識字及低巴氏分數的老年中風住民顯示較多的憂鬱症狀。結論／實務應用　健康照護者需針對中風老人入住機構時進行憂鬱篩選，並定期評估及監測老人的憂鬱狀況，特別是低教育、身體功能差、及居住於護理之家及養護中心的老年住民，需特別關注憂鬱的適當照護。

Background: Stroke is the third leading cause of death in Taiwan. Poststroke older adults are often admitted to long-term care facilities. The impacts of the two concurrent life events of stroke and relocation may increase the risk of depression in stroke survivors. Depression in elderly stroke survivor residents of long-term care facilities has not been studied. Purpose: This study explores the factors associated with depression in older residents with stroke living in long-term care facilities. Methods: A cross-sectional design was used. Twenty-three institutions in southern Taiwan participated in this study, including seven nursing homes, 11 intermediate-care facilities, and five domiciliary-care facilities. Purposive sampling enrolled 111 participants who met the following inclusion criteria: 65 years or older, experienced a stroke that did not cause cognitive defects, and capable of verbal communication. Data were collected using a sociodemographic data questionnaire, Barthel's Index, and the Taiwan Geriatric Depression Scale. Results: Depression was experienced by 41 of the 111 participants (36.9%). Prevalence of depression was 45.7% in nursing homes, 36.2% in intermediate-care facilities, and 22.2% in domiciliary-care facilities. Participants living in nursing homes and intermediate-care facilities and illiterate participants with low Barthel's Index scores showed more depressive symptoms. Conclusions/Implications for Practice: Healthcare providers should conduct depression screening for elderly residents with stroke on admission to long-term care facilities. Regular assessment and monitoring of depressive symptoms, especially in residents with less formal education and limited physical functions, are important in nursing homes and intermediate-care facilities.

1. Li, S. C.,Wang, K. Y.,Lin, J. C.(2003).Depression and related factors in elderly patients with occlusion stroke.The Journal of Nursing Research,11(1),9-18.
   連結：
2. Lin, I. C.、Yu, S. M.、Chang, H. J.(2004)。A survey of depression and its related factors of the institutionalized and non-institutionalized elderly in Hsin-Tien City。Taiwan Journal of Family Medicine，14(2)，81-93。
   連結：
3. Ministry of the Interior. (2012). Establishment standards of senior citizens' welfare institutions. Retrieved from http://sowf.moi.gov.tw/04/02/02_3.htm (Original work published in Chinese)
4. Ministry of Health and Welfare. (2013). Annual statistical report of causes of death in 2012, Taiwan. Retrieved from http://www.mohw.gov.tw/cht/DOS/DisplayStatisticFile.aspx?d=13718&s=1(Original work published in Chinese)
5. Ministry of the Interior. (2012). Population by age. Retrieved from http://sowf.moi.gov.tw/stat/year/y02-01.xls (Original work published in Chinese)
6. Bai, Y. L.,Chiou, C. P.,Chang, Y. Y.,Lam, H. C.(2008).Correlates of depression in type 2 diabetic elderly patients: A correlational study.International Journal of Nursing Studies,45(4),571-579.
7. Chang, Y. S.,Ling, S. C.,Chen, M. C.,Lu, M. R.(2006).Quality of life in elderly with depression disorder.Taiwan Geriatrics & Gerontology,2(1),21-31.
8. Chen, R. L.,Balami, J. S.,Esiri, M. M.,Chen, L. K.,Buchan, A. M.(2010).Ischemic stroke in the elderly: An overview of evidence.Nature Reviews Neurology,6(5),256-265.
9. Cheng, Y. Y.、Chou, C. L.、Cheng, S. P.、Liu, T. J.、Chan, R. C.、Wong, W. J.(2005)。Risk factors of post stroke depression in middle-aged adults and the elderly。Taiwan Journal of Physical Medicine and Rehabilitation，33(3)，149-159。
10. Chung, P. J.,Chiou, C. J.,Chou, F. H.(2009).Relationships between health status, depression and cognitive functions of institutionalized male veterans.Archives of Gerontology and Geriatrics,49(2),215-219.
11. Drageset, J.,Eide, G. E.,Ranhoff, A. H.(2011).Depression is associated with poor functioning in activities of daily living among nursing home residents without cognitive impairment: Depression and activity of daily living.Journal of Clinical Nursing,20(21-22),3111-3118.
12. Ellis, C.,Zhao, Y.,Egede, L. E.(2010).Depression and increased risk of death in adults with stroke.Journal of Psychosomatic Research,68(6),545-551.
13. Farner, L.,Wagle, J.,Engedal, K.,Flekkøy, K. M.,Wyller, T. B.,Fure, B.(2010).Depressive symptoms in stroke patients: A 13 month follow-up study of patients referred to a rehabilitation unit.Journal of Affective Disorders,127(1-3),211-218.
14. Faul, F.,Erdfelder, E.,Lang, A. G.,Buchner, A.(2007).G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences.Behavior Research Methods,39(2),175-191.
15. Fernandes, T. G.,Goulart, A. C.,Santos-Junior, W. R.,Alencar, A. P.,Bensenor, I. M.,Lotufo, P. A.(2012).Educational levels and the functional dependence of ischemic stroke survivors.Cadernos de Saude Publica,28(8),1581-1590.
16. Hackett, M. L.,Yapa, C.,Parag, V.,Anderson, C. S.(2005).Frequency of depression after stroke: A systematic review of observational studies.Stroke,36(6),1330-1340.
17. Hair, J. F.,Black, W. C.,Babin, B. J.,Anderson, R. E.,Tatham, R. L.(2006).Multivariate data analysis.Englewood Cliffs, NJ:Prentice-Hall.
18. Hornsten, C.,Molander, L.,Gustafson, Y.(2012).The prevalence of stroke and the association between stroke and depression among a very old population.Archives of Gerontology and Geriatrics,55(3),555-559.
19. Jongenelis, K.,Pot, A. M.,Eisses, A. M. H.,Beekman, A. T. F.,Kluiter, H.,Ribbe, M. W.(2004).Prevalence and risk indicators of depression in elderly nursing home patients: The AGED study.Journal of Affective Disorders,83(2),135-142.
20. Lai, S. M.,Studenski, S.,Richards, L.,Perera, S.,Reker, D.,Riglers, S.,Duncan, P. W.(2006).Therapeutic exercise and depressive symptoms after stroke.Journal of the American Geriatric Society,54(2),240-247.
21. Laidlaw, K.,Wang, D.,Coelho, C.,Power, M.(2010).Attitudes to ageing and expectations for filial piety across Chinese and British cultures: A pilot exploratory evaluation.Aging & Mental Health,14(3),283-292.
22. Lee, Y.,Choi, K.(2002).Functional disability of older persons in long-term care facilities in Korea.Archives of Gerontology and Geriatrics,34(2),93-106.
23. Liao, Y. C.、Yeh, T. L.、Yang, Y. K.、Lu, F. H.、Chang, C. J.、Ko, H. C.、Lo, C. M.(2004)。Reliability and validation of the Taiwan Geriatric Depression Scale。Taiwanese Journal of Psychiatry，18(1)，30-41。
24. Lin, L. C.,Wang, T. G.,Chen, M. Y.,Wu, S. C.,Portwood, M. J.(2005).Depressive symptoms in long-term care residents in Taiwan.Journal of Advanced Nursing,51(1),30-37.
25. Lin, L. P.(2007)。Depression among the elderly: The review of epidemiological analysis and prevention strategies。Taiwan Journal of Gerontological Health Research，3(1)，53-64。
26. Lin, P. C.,Wang, H. H.,Huang, H. T.(2007).Depressive symptoms among older residents at nursing homes in Taiwan.Journal of Clinical Nursing,16(9),1719-1725.
27. Mahoney, F. I.,Barthel, D. W.(1965).Functional evaluation: The Barthel Index.Maryland State Medical Journal,14(2),56-61.
28. Pfeiffer, E.(1975).A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients.Journal of the American Geriatrics Society,23(10),433-441.
29. Richardson, J.,Bedard, M.,Weaver, B.(2001).Changes in physical functioning in institutionalized older adults.Disability and Rehabilitation,23(15),683-689.
30. Robinson, R. G.(2003).Poststroke depression: Prevalence, diagnosis, treatment, and disease progression.Biological Psychiatry,54(3),376-387.
31. Schmid, A. A.,Damush, T.,Tu, W.,Bakas, T.,Kroenke, K.,Hendrie, H. C.,Williams, L. S.(2012).Depression improvement is related to social role functioning after stroke.Archives of Physical Medicine and Rehabilitation,93(6),978-982.
32. Shyu, Y. I. L.,Tang, W. R.,Tsai, W. C.,Liang, L.,Chen, M. C.(2006).Emotional support levels can predict physical functioning and health related quality of life among elderly Taiwanese with hip fractures.Osteoporosis International,17(4),501-506.
33. Tsai, Y. F.,Chung, J. W. Y.,Wong, T. K. S.,Huang, C. M.(2005).Comparison of the prevalence and risk factors for depressive symptoms among elderly nursing home residents in Taiwan and Hong Kong.International Journal of Geriatric Psychiatry,20(4),315-321.
34. Whyte, E. M.,Mulsant, B. H.(2002).Post stroke depression: Epidemiology, pathophysiology, and biological treatment.Biological Psychiatry,52(3),253-264.
35. Williams, C. L.,Rittman, M. R.,Boylstein, C.,Faircloth, C.,Haijing, Q.(2005).Qualitative and quantitative measurement of depression in veterans recovering from stroke.Journal of Rehabilitation Research & Development,42(3),277-290.
36. Yuan, H. W.,Wang, C. X.,Zhang, N.,Bai, Y.,Shi, Y. Z.,Zhou, Y.,Wang, Y. J.(2012).Poststroke depression and risk of recurrent stroke at 1 year in a Chinese cohort study.PLoS One,7(10),e46906.

1. 曾嬿婷,張淑鈞,林碧珠(2023)。長照機構老人憂鬱與焦慮程度調查。台灣健康照顧研究學刊，27，1-24。
2. 王明鳳(2015)。長者為中心的個別化照顧服務思維～以行動學具車運用於臥床老人服務方案為例。社會工作實務與研究學刊，2，41-72。
3. 張宏哲,王昭琪(2018)。臺灣地區中老年人宗教性與生活滿意度及憂鬱情緒之相關性研究。長期照護雜誌，22(2)，147-169。