以健康信念模式探討社區老人預防衰弱行為之相關因子

Chia-Hui Ko; 柯䕒惠

請用此 Handle URI 來引用此文件： http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/84660

完整後設資料紀錄

DC 欄位	值	語言
dc.contributor.advisor	黃璉華(Lian-Hua Huang)
dc.contributor.author	Chia-Hui Ko	en
dc.contributor.author	柯䕒惠	zh_TW
dc.date.accessioned	2023-03-19T22:19:28Z	-
dc.date.copyright	2022-10-14
dc.date.issued	2022
dc.date.submitted	2022-09-13
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Journal of Gerontology: Social Sciences, 53B(1), S9–S16. https://doi.org/10.1093/geronb/53B.1.S9 Strecher, V. J., De Vellis, B. M., Becker, M. H., & Rosenstock, I. M. (1986). The role of self-efficacy in achieving health behavior change. Health Education Quarterly, 13(1), 73-92. https://doi.org/10.1177/109019818601300108. Tomata, Y., Sugiyama, K., Kaiho, Y., Sugawara, Y., Hozawa, A., & Tsuji, I. (2016). Predictive ability of a simple subjective memory complaints scale for incident dementia: Evaluation of Japan’s national checklist, the “Kihon checklist”. Geriatrics & Gerontology International, 17(9), 1300-1305. https://doi.org/10.1111/ggi.12864 Walston, J., Hadley, E.C., Ferrucci, L., Guralnik, J.M., Newman, A.B., Studenski, S.A., Ershler, W.B., Harris, T., & Fried, L.P. (2006). Research agenda for frailty in older adults toward a better understanding of physiology and etiology: Summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. The American Geriatrics Society, 54(6), 991-1001. https://doi.org/10.1111/j.1532-5415.2006.00745.x Woodhouse, K. W., Wynne, H., Baillie, S., James, O. F. W., & Rawlins, M. D. (1988). Who are the frail elderly? Quarterly Journal of Medicine, 68(255), 505-506. http://doi.org/ 10.1093/oxfordjournals.qjmed.a068216 World Health Organization. (2015). World report on ageing and health. https://apps.who.int/iris/handle/10665/186463 World Health Organization. (2017, August 29). Clinical Consortium on Healthy Ageing. Topic focus: frailty and intrinsic capacity. https://www.who.int/publications/i/item/WHO-FWC-ALC-17.2 World Health Organization. (2017). Integrated care for older people: guidelines on community-level interventions to manage declines in intrinsic capacity. https://apps.who.int/iris/handle/10665/258981 Wu, I. C., Lin, C. C., & Hsiung, C. A. (2015). Emerging roles of frailty and inflammaging in risk assessment of age-related chronic diseases in older adults: The intersection between aging biology and personalized medicine. Biomedicine, 5(1), 1-10. https://doi.org/ 10.7603/s40681-015-0001-1 Wu, Y. H., Liu, L. K., Chen, W. T., Lee, W. J., Peng, L. N., Wang, P. N., & Chen, L. K. (2015). Cognitive function in individuals with physical frailty but without dementia or cognitive complaints: Results from the I-Lan longitudinal aging study. Journal of the American Medical Directors Association, 16(10), 899.e9-e16. http://dx.doi.org/10.1016/j.jamda.2015.07.013 Yee, T. W., & Wild, C. J. (1996). Vector generalized additive models. 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dc.identifier.uri	http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/84660	-
dc.description.abstract	台灣在2018年成為高齡社會，持續增加的老年人口，將對社會及健康照護體系帶來極大的威脅。衰弱是伴隨老化生理系統儲備能力減損、健康風險增加的狀態，會造成跌倒、失能及死亡等不良預後，而慢性疾病與老化造成的加乘效應，更增加衰弱的風險，其衍生而來的照護問題也將耗費龐大的社會和醫療成本。不過，健康的生活方式和預防特定衰弱風險因子可以預防和延緩衰弱，本研究以健康信念模式為基礎架構，探討社區長者健康信念、預防衰弱健康行為與衰弱之關係及重要預測因子。研究方法採橫斷式研究，對240位居住於臺北市大安區65歲以上社區長者進行Kihon Checklist (KCL)衰弱篩檢與健康信念問卷調查。研究結果顯示社區之衰弱長者以高齡、多重慢病者居多，半數以上的研究對象不知道衰弱症及預防方法，同時也缺乏衰弱相關知識的來源管道。健康信念與衰弱的關係中發現，衰弱組受到衰弱症的威脅感高於衰弱前期組與無衰弱長者，且認同完整的健康狀態可以擁有較高生活品質，有較高健康信念(p< .001)；自我效能(p< .001)和預防衰弱行為(p< .001)則顯示衰弱組的長者受到身心退化、疾病及生活障礙等影響，對預防衰弱之健康促進行為的信心和執行力皆較其他兩組差。多變量線性迴歸分析運用廣義相加模型（含交互作用）進行衰弱因子之預測，結果顯示年齡越長則衰弱程度越高且有劑量效應的關係，90歲(含)以上(p< .0001)、85-89歲(p= .0097)、80-84歲(p= .0036)、75-79歲(p= .0061)為顯著；非獨居有中風(p= .0004)、非獨居有視力問題(p= .0045)、關節炎(p= .0002)、骨折或關節損傷(p= .0017)、經濟非充裕(p= .0409)、知識總分≤ 3.8分(p= .0484)的長者皆為衰弱的風險因子。在健康信念的部分，自覺罹患性(p< .0001)和自覺行動利益(p= .0247)分數越高則越衰弱，自我效能(p< .0001)分數越高則越不衰弱為保護因子，自覺嚴重性分數≤5.9分或>12.8分(p= .0008)比較衰弱，獨居且採取預防衰弱行動線索(p< .0001)的長者也偏向衰弱。結果可被全體自變項共同解釋62.8%。研究對象衰弱篩檢(KCL)之異常構面依序為運動功能(37.1%)、口腔功能(25.4%)、憂鬱傾向(16.9%)、認知(16.2%)、生活(13.3%)、社會功能(12.8%)及營養(9.3%)。Kruskal-Wallis rank-sum test結果顯示衰弱症之特定風險為運動功能異常、口腔功能異常和憂鬱傾向，受到年齡和累積疾病數的影響最劇，而經濟的匱乏則可能加重衰弱情形。建議社區衰弱防治策略，首先在「可近性」的部分增加衰弱知識和預防方法的來源管道，如結合醫療院所和門診，對有就醫習慣的長者定期篩檢與衛教，降低長者行動線索的障礙。次為「教育面」，依照長者衰弱程度設計不同強度、複合式主題的健康促進內容或強化訓練，加深長者對衰弱症的健康信念，運用自我效能為衰弱症的保護因子，著重在使能(enabling)、復能(reablement)和建構支持性環境，協助長者發展特定生活功能之熟練經驗，增進或維持長者活動機能與適應能力。第三部分為「照顧面」，以老人為中心預防和延緩失能，從健康服務中心、衛生所到醫療院所實行衰弱防治三段五級的照護模式，落實持續和完整的照護網絡；對衰弱長者提供個案管理、復能訓練、建構支持性環境、專業醫療照護、長期照顧服務等；對衰弱前期、高風險長者邀約健康訓練或促進課程，使長者在有限的內在能力(intrinsic capacity, IC)下，將功能能力(functional ability, FA)最大化，盡可能地減低失能或降低對社會的依賴，達到最佳與獨立的功能狀態，成功邁向健康老化。	zh_TW
dc.description.abstract	Taiwan has become an aged society since 2018. Frailty is an age-related syndrome characterized by declining functioning across multiple physiological systems. Effective methods to prevent or delay the onset of frailty are urgently needed in aging societies. Lifestyle and clinical risk factors are potentially modifiable by specific interventions and preventive actions. The purpose of this study was to investigate frailty status and associated factors in health beliefs and frailty prevention behavior among community-dwelling elderly. This research was a cross-sectional study. A total of 240 aged 65 and over were recruited from home visits and health promotion courses by community nurses in Taipei city. Categorized by Kihon Checklist (KCL) index, scores of 0-3 classified as robust (n=120), 4-7 as pre-frail (n=60), and 8+ as frail (n=60). Structured questionnaires based on the Health Belief Model (HBM) were used to collect data. The research participants were 65% women aged 65 to 98 years. The frail elderly were mainly of advanced age and had multiple chronic diseases. More than half are unaware of frailty, prevention methods, and action cues. According to the Kruskal-Wallis rank-sum test, frailty was positively correlated with health beliefs (p< .001). Seniors with higher KCL scores were more aware of frailty risks and agreed that being in good health is associated with a higher quality of life. Furthermore, self-efficacy (p< .001) and frailty prevention behavior (p< .001) were negatively correlated with frailty, indicating that the frailty elderly would be more protected if they had higher self-confidence and execution ability in implementing healthy behaviors. Multiple linear regressions with generalized additive models (GAMs) and interaction variables were used to predict the total scores of KCL. The results indicated that frailty increased with age, and a dose-effect relationship was observed. Over 90 years old (p< .0001), 85-89 (p= .0097), 80-84 (p= .0036), and 75-79 (p= .0061) were significantly different. The older persons who did not live alone with stroke (p= .0004), did not live alone with vision impairment (p= .0045), suffering from arthritis (p= .0002), suffering from bone and joint injuries (p= .0017), and having economic insufficiency (p= .0409), knowledge scores ≤ 3.8 (p= .0484) were all risk factors for frailty. A higher perceived susceptibility score (p< .0001), perceived benefit of action (p = .0247), and perceived severity score of ≤5.9 or >12.8 (p = .0008) were associated with frailty in the health belief model. An increase in self-efficacy (p< .0001) was associated with a decrease in frailty. Elderly individuals who lived alone and took action to prevent frailty (p< .001) were also frailer. In the abnormal aspects of KCL domain, the frailty group had the worst detection results. Of all subjects followed by were poor motor function (37.1%), oral dysfunction (25.4%), depression tendency (16.9%), mild cognition impairment (16.2%), life dysfunction (13.3%), social dysfunction (12.8%), and nutrition problems (9.3%). Kruskal-Wallis rank-sum test showed three specific risks of frailty, poor movement, oral dysfunction, and depression tendency, strongly influenced by age and the cumulative number of illnesses. At the same time, lack of financial could exacerbate frailness. Recommendations for frailty prevention strategies were three. First, add sources of frailty prevention clues, such as regular screening and health education for the elderly in the outpatient clinic, to the 'accessibility knowledge' section. The second section is 'education.' Design various intensities and comprehensive broad classes to raise awareness of the perceived susceptibility and benefits of prevention frailty, and arrange successful models to enhance their self-efficacy in promoting healthy behavior and lifestyle. The final section is 'caring.' Implements a three-stage and five-level prevention strategy to prevent and delay frailty. Case management provides rehabilitation training, a supportive environment, medical and long-term care, and other services to help older people maximize their functional ability and achieve independence.	en
dc.description.provenance	Made available in DSpace on 2023-03-19T22:19:28Z (GMT). No. of bitstreams: 1 U0001-1209202221152400.pdf: 4344997 bytes, checksum: 43bd2faef91ad5812bc78dd38ddc856b (MD5) Previous issue date: 2022	en
dc.description.tableofcontents	目錄口試委員審定書…………………………………………….……………...…….. i 致謝…………………………………………………………………...…...……... ii 中文摘要…………………………………………………………………..……… iii Abstract..…………………………………………………………………...…...… v 目錄……………………………………………………...………………………... viii 第壹章緒論第一節研究背景與重要性………………………………………………………...1 第二節研究目的…………………………………………………………………...3 第貳章文獻查證第一節衰弱症…………………………………………………………………...…4 第二節預防衰弱………………………………………………………………….11 第三節世界衛生組織健康老化之倡議......……………………………………...15 第四節健康信念模式…………………………………………………………….17 小結 …………………………………………………………………………….21 第參章研究方法第一節研究架構與設計………………………………………………………….22 第二節名詞界定………………………………………………………………….23 第三節研究工具………………………………………………………………….24 第四節效度及信度檢定………………………………………………………….26 第五節資料收集與研究過程…………………………………………………….27 第六節資料統計與分析………………………………………………………….27 第肆章研究結果第一節研究對象基本屬性……………………………………………………….28 第二節衰弱知識分佈與差異分析……………………………………………….31 第三節健康信念之分佈與差異分析…………………………………………….33 第四節自我效能之分佈與差異分析…………………………………………….40 第五節預防衰弱行為之分佈與差異分析……………………………………….43 第六節行動線索之分佈與差異分析..…………………………………………...46 第七節相關分析…..……………………………………………..……………….51 第八節多變量線性迴歸分析…………………………………………………….52 第九節研究對象衰弱篩檢結果之分佈與分析…...…...………………...……....59 第伍章討論第一節社區長者衰弱知識之概況……………………………………………….64 第二節健康信念與衰弱的關係………………………………………………….67 第三節衰弱症的預測因子……………………………………………………….70 第四節研究對象衰弱篩檢之異常構面與分析……..…………………………...72 第陸章結論第一節研究結論與建議………………………………………………………….73 第二節研究限制………………………………………………………………….75 參考文獻 …………………………………………………………...……………….76 附錄附錄ㄧ社區長者預防衰弱行為調查問卷……………………………………….87 附錄二 KCL量表同意授權電子郵件…………………………………………….91 附錄三機關同意函……………………………………………………………….92 附錄四國立臺灣大學行為與社會科學研究倫理委員會審查核可證明……….93 表目錄表3-4-1 研究工具專家效度表…………………………………………….……….….26 表3-4-2 研究工具信度分析表...………………………………………….….…….….26 表4-1-1 研究對象基本屬性……………………………………………….……….….29 表4-2-1 衰弱知識得分狀況……………………………………………….…………..32 表4-2-2 衰弱知識總分之差異分析……………………………………….…………..32 表4-3-1 健康信念：自覺罹患性分佈情形…………………………………….……..35 表4-3-2 健康信念：自覺嚴重性分佈情形…………………………………….……..36 表4-3-3 健康信念：自覺行動利益分佈情形………………………………….……..37 表4-3-4 健康信念：自覺行動障礙分佈情形………………………………….……..38 表4-3-5 衰弱知識總分、健康信念、自我效能、預防衰弱行為之單變量分析…...39 表4-4-1 自我效能分佈情形……...……………………….…………………….……..41 表4-5-1 預防衰弱行為之分佈情形……...……...………….…………………………44 表4-6-1 衰弱程度與行動線索之分佈與差異分析……………….…………….…….48 表4-6-2 居住狀況與行動線索之分佈與差異分析………………………….….…….49 表4-7-1 年齡、疾病計數、衰弱知識總分和健康信念與KCL總分之相關分析..….51 表4-8-1 衰弱預測因子之多變量線性迴歸分析……..……………………………….55 表4-8-2 衰弱預測因子之多變量線性迴歸分析：運用廣義相加模型……………...56 表4-9-1 衰弱量表(KCL)分佈情形………………………..……………...……….…..60 表4-9-2 衰弱量表(KCL)分層變項之分佈情形及差異分析………………..………..61 圖目錄圖2-1 老化與疾病造成的功能衰退及不良預後之機轉…………….……..….…....7 圖2-2 健康信念模式………………………………………………….…….....……18 圖2-3 自我效能在個人行為之作用模型…………...…………..………….……....19 圖2-4 修正之健康信念模式………………………………………………..………20 圖3-1 研究架構圖…………………………………………………………..………22 圖4-1 預防衰弱的方法與知識之行動線索來源…………………………………..50 圖4-2 行動線索2居住狀況、專業醫護人員交互作用與KCL總分之盒鬚圖…....50 圖4-3 知識總分與KCL總分之廣義相加模型圖……………..……………………57 圖4-4 知識總分(兩組)與KCL總分之盒鬚圖……………….………………….….57 圖4-5 自覺嚴重性分數與KCL總分之廣義相加模型圖….……………………….58 圖4-6 自覺嚴重性分數(三組)與KCL總分之盒鬚圖……….……………………..58
dc.language.iso	zh-TW
dc.subject	健康信念模式	zh_TW
dc.subject	社區老人	zh_TW
dc.subject	預防衰弱行為	zh_TW
dc.subject	衰弱症	zh_TW
dc.subject	frailty	en
dc.subject	community elderly	en
dc.subject	health belief model	en
dc.subject	frailty prevention behavior	en
dc.title	以健康信念模式探討社區老人預防衰弱行為之相關因子	zh_TW
dc.title	Factors Related to Frailty Prevention Behavior among Community Elderly: Base on the Health Belief Model	en
dc.type	Thesis
dc.date.schoolyear	110-2
dc.description.degree	碩士
dc.contributor.oralexamcommittee	林艷君(Yen-Chun Lin),張念慈(Nien-Tzu Chang)
dc.subject.keyword	衰弱症,社區老人,健康信念模式,預防衰弱行為,	zh_TW
dc.subject.keyword	frailty,community elderly,health belief model,frailty prevention behavior,	en
dc.relation.page	93
dc.identifier.doi	10.6342/NTU202203324
dc.rights.note	同意授權(限校園內公開)
dc.date.accepted	2022-09-14
dc.contributor.author-college	醫學院	zh_TW
dc.contributor.author-dept	護理學研究所	zh_TW
dc.date.embargo-lift	2024-01-01	-
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