老人的衰弱程與認知功能、自我照顧功能、憂鬱症狀及社會支持之關聯

陳琳嬿

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老人的衰弱程与认知功能、自我照顾功能、忧郁症状及社会支持之关联

The association among the degree of frailty, physical activity function, cognitive function, depression symptoms and social support among the elderly in southern Taiwan

陈琳嬿 , 硕士　　导师：谢秀芬　　

繁体中文

老年人；衰弱前期；衰弱症；身体活动功能；认知功能；忧郁；社会支持； frailty ； elderly ； physical activity ； cognitive function ； depressive symptoms ； social support

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摘要 │ 参考文献 (113) │ 国际计量

摘要〈TOP〉

背景:探讨不同衰弱程度的老年人与其相关影响因素，如认知功能、身体活动功能、忧郁症状及社会支持之关系的研究不多，因此希望探讨此研究，来了解衰弱程度4~6级分老年人之相关影响因素及预测因子，以期望早期发现与及早给予相关介入措施，避免衰弱程度的恶化，并作为未来介入性研究及推动延缓长者衰弱失能政策上的参考。
方法:本研究采横断性的研究设计，在南部某医学中心老年医学科门诊进行收案，使用结构式问卷收集资料，问卷内容包括人口学基本资料、巴氏量表、简易心智状态评估量表、简易老年人忧郁量表与社会支持量表，以皮尔森相关分析来探讨不同的衰弱程度与上述各变项之间的关系，并以逻辑斯回归分析找出老年人不同的衰弱程度的预测因子。
结果:本研究收案116位符合临床衰弱量表4~6级分的老年人完成问卷结果发现，1.约有44.8％的门诊老年人为衰弱4级分；55.2%处於衰弱5~6级分状态；2.巴氏量表平均得分为82.5(±19)分，以中度依赖者居多共53人(45.7%)；在简易心智状态平均得分2.7(±2.7)分，以无心智功能障碍者居多共65(56.0%)；忧郁量表平均得分3.2 (±2.7)分，7~10分有中度情绪困扰者共14人(12.1%)，大於11分以上属於重度情绪困扰者共2人(1.7%)；在社会支持量表平均得分为48.2(±12.0)分，以量表各细项平均分数而言，在工具性社会支持平均得分为11.7(±3.6)分，在情感性社会支持平均得分为20.9(±5.9)分，工具平均得分为11.7(±3.6)分，在自尊性社会支持支持方面平均得分为15.8(±4.4)。3.不同衰弱程度之老年人进行比较，在身体依赖程度(t=6.74，p< .001)、认知功能(t=5.72，p< .001)与忧郁症状(t=-4.0，p= .014)，皆有达统计上之显着差异，而在社会支持(t = .14，p= .89)则无统计上之显着性差异。4.以Pearson 相关因素分析衰弱程度与年龄(r= .562，p< .001)、宗教信仰(r= .194，p< .05)、慢性疾病种类(r= .189，p< .05)、认知功能(r= .534，p< .001) 、老人忧郁程度(r= .315，p< .001)呈现有显着性正相关；而衰弱程度与每周运动型态(r= -.284，p= < .001)、身体活动功能(r=-.6.08，p< .001)呈显着性负相关，即年龄越大、缺乏宗教信仰、慢性疾病种类越多、认知功能障碍越严重、忧郁程度愈高的老年人，发生衰弱的比率也会越高；然而每周运动型态越低、身体活动功能越差，其衰弱程度也越高。另衰弱程度与教育程度(r= -.141，p= .131)、有无同住者(r= .048，p= .612)，以及社会支持(r=.024，p= .80)皆无统计上之显着性关系。5.以逻辑斯回归分析结果发现，预测影响衰弱程度的相关因子包括年龄(OR=1.14，p= .033)、教育程度(OR=1.62，p= .042)、有无宗教信仰(OR = 9.45，p< .032)、身体活动功能(OR= .92，p= .012)、认知功能(OR=1.60，p= .006)、老人忧郁程度(OR = 1.35，p< .048)等，即老年人年龄越高、教育程度越低、缺乏宗教信仰、身体活动功能越差、认知功能越退化、忧郁程度越高者，其衰弱程度也越高。
讨论:本研究发现年龄、教育程度、宗教信仰、身体活动功能、认知功能以及忧郁程度是老人衰弱的预测因子。可以透过社区教育、保持宗教信仰带来的心灵寄托、改善身体活动功能及提升自我的认知功能，以及保持良好的心情，多进行社会互动等方式，以延缓老年人由衰弱前期，进展成衰弱症。与文献结果有所不同发现社会支持不是老年人衰弱的预测因子，因随着社会结构改变，老年人也提早开始规划退休生活，加上不再强调养儿防老的观念，觉得为人子女首先要将自己照顾好，有余力再照顾家中长辈即可，故建议将华人社会文化结构改变纳入研究之参考。

并列摘要〈TOP〉

Background: There are not many studies on the relationship between the elderly with different degrees of frailty and related influencing factors, such as cognitive function, physical activity function, depression symptoms and social support. Therefore, I hope to explore this research to understand the degree of frailty 4-6 grades of elderly Human-related influencing factors and predictive factors are expected to be detected early and relevant intervention measures are given early to avoid the deterioration of debilitating degree, and serve as a reference for future interventional research and promotion of debilitating and disabling policies for the elderly.

Methods: This study adopted a cross-sectional research design. The case was collected in the outpatient clinic of the Department of Geriatrics of a Medical Center in the South. The structured questionnaire was used to collect data. The content of the questionnaire included basic demographic data, Pap scale, and simple mental state assessment. Table, Simple Elderly Depression Scale and Social Support Scale, Pearson correlation analysis is used to explore the relationship between different degrees of debilitating and the above variables, and logistic regression analysis is used to find out the different degrees of debilitating elderly Predictor.

Results: In this study, 116 elderly people who met the clinical frailty scale 4-6 grades completed the questionnaire and found that 1. About 44.8% of the outpatient elderly were frail 4 grades; 55.2% were frail 5-6 grades; 2. The average score of the Pap scale is 82.5 (±19) points, with 53 people (45.7%) being moderately dependent; the average score in simple mental states is 2.7 (±2.7) points, and 65 (56.0%) people without mental dysfunction ); The depression scale has an average score of 3.2 (±2.7) points, a total of 14 people (12.1%) with moderate emotional distress from 7 to 10 points, and a total of 2 people (1.7%) with severe emotional distress over 11 points; The average score of the social support scale is 48.2 (±12.0) points. In terms of the average score of each item of the scale, the average score of instrumental social support is 11.7 (±3.6) points, and the average score of emotional social support is 20.9 ( ±5.9) points, the tool average score is 11.7 (±3.6) points, and the average score of self-esteem social support is 15.8 (±4.4). 3. Comparing the elderly with different degrees of frailty, the degree of physical dependence (t=6.74, p< .001), cognitive function (t=5.72, p< .001) and depression symptoms (t=-4.0, p= .001) 014), both have reached a statistically significant difference, while there is no statistically significant difference in social support (t = .14, p = .89). 4. Use Pearson related factors to analyze the degree of frailty and age (r= .562, p< .001), religious belief (r= .194, p< .05), and types of chronic diseases (r= .189, p< .05) ), cognitive function (r= .534, p< .001), and the degree of depression in the elderly (r= .315, p< .001) showed a significant positive correlation; and the degree of weakness was related to the weekly exercise pattern (r=- .284, p= <.001), physical activity function (r=-.6.08, p< .001) showed a significant negative correlation, that is, the older the age, the lack of religious belief, the more types of chronic diseases, and the more cognitive dysfunction The older the more serious and the higher the depression, the higher the rate of weakness; however, the lower the weekly exercise pattern and the worse the physical activity, the higher the degree of weakness. In addition, the degree of frailty and education (r= -.141, p= .131), the presence or absence of co-residents (r= .048, p= .612), and social support (r=.024, p= .80) Statistically significant relationship. 5. Based on the results of logistic regression analysis, it is found that the relevant factors that predict the degree of debilitating include age (OR=1.14, p=.033), education level (OR=1.62, p= .042), and whether there is religious belief (OR = 9.45) , P< .032), physical activity function (OR= .92, p= .012), cognitive function (OR=1.60, p= .006), depression degree of the elderly (OR=1.35, p< .048), etc., That is to say, the older the elderly, the lower the education level, the lack of religious beliefs, the worse the physical activity function, the more degraded cognitive function, and the higher the degree of depression, the higher the degree of weakness.

Conclusions: This study found that age, education level, religious beliefs, physical activity function, cognitive function, and depression are the predictors of frailty for the elderly. Through community education, maintaining spiritual sustenance brought about by religious beliefs, improving physical activity and enhancing self-cognition, as well as maintaining a good mood, more social interactions, etc., can delay the progression of the elderly from pre-debilitating to debilitating disease . Different from the results in the literature, it is found that social support is not a predictor of the frailty of the elderly. As the social structure changes, the elderly also start planning their retirement life early. In addition, they no longer emphasize the concept of raising children to prevent the elderly. Take good care of yourself and take care of the elders in your family if you have the extra energy. Therefore, it is recommended that the changes in the social and cultural structure of Chinese people be included in the research.

参考文献 ( 113 ) 〈TOP〉

叶淑娟、施智婷、庄智薰、蔡淑凤(2004)．社会支持系统与老人生活满意度之关系-以高雄市老人为例．中山管理评论，12(2)，399-427。
连结：
中文部分
内政部统计处(2018)．NEW107年简易生命表．取自https://reurl.cc/zy9x4V
方佩欣、张睿诒(2020)．高龄社区长者社会衰弱之范域文献回顾．台湾公共卫生杂志，39(2)，112-128。
王斗、郝玉芳、李怡、关欣(2019)．老年衰弱评估工具在国内的应用进展．中华现代护理杂志，25 (10)，1205~1208。

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