自按式穴位按壓對於老年人疲勞及生活品質之影響

Abstract

前言：疲勞是一種個人經驗，來自於生理或心理的疲勞、勞累和虛弱的狀態，有一種完全耗竭的感覺。疲勞在老年人中有很高的盛行率，疲勞會導致日常活動功能的減退、增加失能風險、日常生活品質的下降與死亡率的提高。台灣因為人口老化所帶來各種沉重的經濟負擔是必須面對的嚴肅課題。穴位按壓是傳統中醫學治療與保健的方法，有許多研究證實穴位按壓的有效性，包含改善疼痛、疲勞、憂鬱、焦慮及壓力和睡眠品質與生活品質。如果可以利用自按式穴位按壓來改善老年人疲勞症狀與生活品質，不僅可以達成促進老人健康的目的，甚至可以有機會打造成功老化的社會。 目的：探討自按式 (self administered ) 穴位按壓(acupressure)對老年人疲勞(fatigue)與生活品質(quality of life)的影響，與相關的影響因素。 研究方法：本研究採單組前後測試設計實驗法，並以立意取樣方法進行收案。針對台北市和新北市老年公寓中的長者進行一週三次，總共一個月十二次、每次十五分鐘的自按式 (self administered ) 穴位按壓(acupressure)。自按式穴位按壓為本研究的自變項。老年人的疲勞與生活品質為本研究的依變項。控制變項為性別、年齡、婚姻狀況與教育程度。研究對象來自兩個老人公寓的住民，並有疲勞現象。經中醫師教導後，進行穴位按壓，評估穴位按壓介入的前後在疲勞與生活品質的改變，與影響疲勞與生活品質改變的相關因素。 結果：研究結果顯示，疲勞經穴位按壓的前後測結果比較顯示，疲勞的平均總分由前測的4.40分(SD=±1.79分)下降到後測的3.69分(SD=±1.86分)(P=0.005)， 在前兩週的一般疲勞程度由前測4.88分(SD=±1.69分)下降到後測的4.17分(SD=±2.10分) 顯著改善(P=0.039)與前兩週的最疲勞程度由前測6.05分(SD=±2.24)下降到後測的5.05分(SD=±2.63分)顯著改善(P=0.020)。而在疲勞影響日常生活功能項目中，包含對於疲勞影響行走能力程度結果(P=0.024)改善與疲勞影響日常工作程度(P=0.003)的結果也改善。生活品質經穴位按壓的一般健康項目的前後測結果比較顯示，由前測38.67分(SD=±6.02分)上升到後測的42.58分(SD=±7.17分)，結果改善(P=0.002)，心智健康方面，前後測結果比較，由前測49.19分(SD=±7.23分)上升到後測的51.09分(SD=±4.59分)，也有改善(P=0.025)。而其他的項目沒有明顯差異。 結論與建議：本研究結果指出，進行自按式穴位按壓對於老年人疲勞與生活品質有改善效果。建議未來可以經評估後可進行教學推廣推廣老年人自按式穴位按壓，以改善老年人疲勞、行走能力、日常工作及生活品質中的一般健康與心智健康。在未來穴位按壓可進一步提供作為老年人促進健康與未來減緩失能的實施選項。

Background：The fatigue is personal experience, from physical and psychological tiredness, strain and weakness status, with a sensation of extreme exhaustion. There is a high prevalence rate in older adults population. The fatigue will induce daily activity reduced, risks of disability development increased, quality of life reduced and mortality rate increased. Taiwan must face the serious issue that aging brings the tremendous loading economic expenditure. The acupressure is a traditional Chinese medicine treatment and health promotion practice and there are many evidences to the effectiveness, including the improving pain, fatigue, depression, anxiety, pressure , sleep disorder and quality of life. If we could use the self administered acupressure to improve the older adults fatigue and quality of life, there is a chance not only to enhance the older adults health but also to make a successful aging society. Objectives：The objective of the study is to investigate the effects of self administered acupressure on fatigue and quality of life in older adults. Methods：The study design was a single group with pretest and posttest design. The subjects of this study were older adults lived in Taipei City and New Taipei City older adults apartments. The self administered acupressure were practiced with three times a week , 15 minutes each time and persisted 12 times. The independent variable is acupressure. The dependent variables are fatigue and quality of life in older adults. The control variables are sex, age, marriage and education level. After teaching the older adults acupressure practice, the researcher investigated the difference about the fatigue and quality of life between the intervention of self administered acupressure.

Results：The results showed the fatigue pretest total score was 4.40 (SD=±1.79) decreased to the posttest score 3.69 (SD=±1.86)(P=0.005). The fatigue pretest general score was 4.88 (SD=±1.69) decreased to the posttest score 4.17 (SD=±2.10)(P=0.039). The fatigue pretest most severe score was 6.05 (SD=±2.24) decreased to the posttest most severe score 5.05 (SD=±2.63)(P=0.020). In the items of fatigue impact on daily activities, the score of fatigue impact on walking ability improved (P=0.024) and the score of fatigue impact on daily working improved (P=0.003). The pretest score of general health item of quality of life after the acupressure was 38.67 (SD=±6.02) improved to posttest score 42.58(SD=±7.17)(P=0.002). The pretest score of mental health of quality of life was 49.19 (SD=±7.23) improved to posttest score 51.09 (SD=±4.59)(P=0.025). There were no obvious difference in other items. Conclusions and Recommendations： This study indicated self administered acupressure were effective for improvement of fatigue and quality of life in older adults. We suggested that after evaluating these older adults we could teach the self administered acupressure to improve the fatigue, walking ability, daily working and general health and mental health of quality of life. Further the acupressure practice could be provided to the older adults for the health promotion and decreased disability.