內科住院老人出院後安置狀況預測因子之探討

葉湘芬

慈濟技術學院護理系

摘要

隨著人口老化與疾病型態的轉變，失能老人安置之課題更形重要。本研究目的為探討出院後老人安置狀況之預測因子，採前瞻性病例對照研究設計(prospective case-control study)，以北部某醫學中心共選取50位內科擬出院老人為研究對象，個案組為出院轉介服務之安療養院安置老人25人；對照組25人為以個案組1：1時間配對(time-matching)之居家療養老人。收案方式應用結構式問卷評估出院前老人與主要照顧者之特性、老人之生理狀況與活動、認知情緒功能。研究結果顯示，超長住院、照顧者希望老人出院安置於安療養院、入院前居住於安療養院、出院時身上有管路、生理狀況差、認知及情緒問題重度缺損、日常活動功能及工具性日常活動功能高度依賴者與採用安療養院安置有顯著相關，並以工具性日常活動功能為0分、入院前居住於安療養院與超長住院為出院採用安療養院安置之最佳預測因子。本研究有關出院後老人安置狀況之預測因子可提供政府、醫療單位及出院準備服務人員，規劃老人出院安置之重要依據。

關鍵字：出院後老人、安療養院安置、出院轉介、預測因子



Predictors of Disposition for Elderly Internal
Medicine Patients after Hospital Discharge
Hsiang-Fen Yeh

Department of Nursing

Tzu Chi College of Technology

Abstract
Along with the aging of population and the changing of disease types, the needs of the disabled elderly persons for nursing home displacement become more important. The purpose of this study was to explore the predictors for the nursing home disposition. A total of 50 pre-discharged medical elders from a medical center were recruited through a case-control study design. The case group consist of 25 elders discharge to nursing homes. These subjects were referred by the discharge planning services of the medical center. The control group consisted of patients who were discharged to home without using home nursing services. According to the ratio of 1 to1, 25 elders in the control group for nursing home disposition group were selected by time-matching random sampling. Structural questionnaires were used to assess the characteristics of the elders and their caregivers, and the physical conditions and activity functions of the elders. The results of this study showed that patients delayed discharge, caregiver's preference for nursing home disposition, living in nursing homes before hospital admission, patients discharged with tubes, poor physiological functions, and being highly dependent on ADLs and IADLs were significantly related to nursing home disposition. Patients with an IADL score of 0, living in nursing homes before hospital admission, and delayed discharge were the best predictors of nursing home disposition. The findings can provide a basis for decision making for discharge planning services. Discharge planners will be able to arrange more appropriate referrals for hospitalized elders and their caregivers. Further more, their information can provide reference for future development of long-term care resources in Taiwan.

Key word：discharged elders, nursing home disposition, discharge referrals, predictors for disposition