急性住院年長者憂鬱症狀現況及其影響因素探討

Abstract

背 景：老年憂鬱症患者往往合併身體上的疾病，導致失能和死亡率增加等 問題，過去研究多對於社區和慢性機構的年長者進行憂鬱症狀的調查，較少研究探討急性住院年長者憂鬱症狀的現況及其主要影響因素。 目 的：探討急性住院年長者的憂鬱症狀現況，以及探討下列因素中何者為 主要影響因素，包含：社會人口學、身體健康狀況、健康行為、日常生活功能，以及知覺接受他人疼惜。 方 法：本研究採橫斷式描述性相關性研究設計(cross-sectional correlation design)，以北部某醫學中心老年醫學部住院年長者為研究對象，採立意取樣(purposive sampling)，使用結構式問卷進行資料收集，包括「社會人口學基本資料表」、「身體健康狀況量表」、「健康行為量表」、「老年憂鬱量表；GDS」、「日常生活功能評估；ADL」以及「中文版疼惜承諾與行動量表：知覺接受他人疼惜」。經由研究者以一對一訪談方式收集資料。 結 果：本研究樣本為113位日常生活功能多為中度依賴並和子女同住在社 區的年長者，因為感染而急性住院。在整體的憂鬱症狀方面，82.3%的住院年長者無出現憂鬱症狀(GDS-15 總分為0-4分)，1.8%的住院年長者達到憂鬱症診斷(GDS-15總分≧10分)，15.9%出現臨床相關憂鬱症狀(GDS-15總分5-9分)。整體憂鬱症狀(GDS-15)的主要預測因子為宗教信仰，入院期間自覺睡眠品質狀況，及入院前運動習慣。影響急性住院年長者出現臨床憂鬱症狀(GDS總分≧5分)的主要影響因素為住院期間的睡眠品質和治療後日常生活功能。關於兩題對於生活具有負面看法的憂鬱症狀 (生活空虛和生活不滿意程度)(GDS-2)的主要預測因子包含：社會人口學-經濟狀況，健康行為-飲酒及運動時數，心理-知覺接受他人疼惜的程度。 結 論：因急性住院的年長者多數沒有出現憂鬱症狀。宗教信仰，入院前的 健康行為包含運動，沒有飲酒習慣為憂鬱症的保護因子，入院時的睡眠品質為影響其憂鬱的危險因子。治療後的日常生活功能與憂鬱程度無關但與是否出現臨床意義憂鬱症狀相關。知覺接受他人疼惜和整體憂鬱無關但和其中2題對生活負面描述憂鬱症狀相關。本研究結果對於未來發展預防急性住院年長者憂鬱有所助益。

Background: Suffering from both depressive and physical disorder among elderly people, increased mortality and disability. The previous studies on depression mainly focused on elderly people in community or chronic institutions. Very few studies examine depressive symptoms and its associated factors among elderly people who are admitted to acute inpatient ward. Purpose/Objectives: This study aimed to examine the depressive symptoms among elderly people who were admitted to an acute inpatient unit and the associated factors including social demographic characteristics, physical health status, healthy behavior, activities of daily living, and the perception of compassion from others. Methods: This study adopted, a cross-sectional descriptive correlational design. With the method of purposive sampling, the participants were recruited from the acute inpatient unit of the department of geriatrics and gerontology at the medical center in the north of Taiwan. Data were collected by using the structured questionnaires through person to person interview:“social demographic characteristics questionnaire,” “physical health status questionnaire,” “healthy behavior questionnaire,” “Short-form 15-item Geriatric Depression Scale (GDS-15),” “Activities of daily living (ADLs),” “Chinese version Compassionate Engagement and Action Scale: Compassion from others”. Results: Total 113 elderly people with moderate level of dependence are the participants of this study. Mostly they lived in the community with their children and they were admitted to the acute inpatient ward for infection. About the total scores for GDS-15, there were 82.3% with no depression (total scores 0-4), 1.8% with depressive disorder (total scores ≧10), 15.9% with clinically depressive symptoms (total scores 5-9). The factors associated with total scores for GDS-15 were the religious belief, regular exercise habits, and sleep quality at the time of admission in the hospital. The main predictors of with/without clinical depressive symptoms were sleep quality at the time of admission in the hospital and the levels of activities of daily living after acute medical treatments. The factors associated with 2-item GDS relating to negative thought about daily life (the degree of emptiness and dissatisfaction of life) were economic status hours of exercise and drinking habits, and the ability of perceptions of compassion from others. Conclusions: Majority of elderly people at acute inpatient ward do not appear to have depressive symptoms. Religion, healthy behaviors including exercise and no drinking habit are the protective factors of depression. Sleep quality at time of admission in the hospital is the risk factor of depression. The levels of activities of daily living after acute medical treatments are not associated with depressive levels but are correlated with meeting the criteria of the clinical depressive symptoms. Perception of compassion from others is not related with total scores of GDS-15 but it is correlated with 2-item depressive symptoms which describe the negative thought about life. The findings of this study could be helpful to develop the depression prevention program for elderly people who are admitted to acute inpatient ward.