高齡病房關於老年期憂鬱症與生活品質之探索性研究

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題名:	高齡病房關於老年期憂鬱症與生活品質之探索性研究 Late-life Depression and Quality of Life in a Geriatric Evaluation and Management Unit: An Exploratory Study
作者:	林叡鴻;Jui-Hung Lin
貢獻者:	臨床醫學研究所碩士班
關鍵詞:	老人;老年期憂鬱症;老人憂鬱症;生活品質;生活品質量表;高齡病房;台灣;巴式量表;老人憂鬱量表;多元評估量表;長期照顧;長照;周全性老年醫學評估;周全性老年評估;Elderly;late-life depression;geriatric depression;quality of life;EQ-5D;geriatric evaluation and management unit;GEMU;Taiwan;ADL;GDS;multidimensional assessment instrument;MDAI;long-term care;comprehensive geriatric assessment;CGA
日期:	2014-06-27
上傳時間:	2014-10-02 09:45:45 (UTC+8)
出版者:	中國醫藥大學
摘要:	背景老年期憂鬱症在高齡的病人相當常見。如果我們忽視了老年期憂鬱症的重要性，不管是因為疏於診斷或是治療不足，都會導致額外的醫療支出與更多的合併症。為了追求更好的生活品質，評估、預防與治療老年期憂鬱症是相當重要的事。方法這個研究主要在檢視 (1) 憂鬱症對高齡住院病人在他們出院時，在臨床上的表徵、生活品質的進步程度以及功能性的進步有何重要影響 (2) 還有那些因素會影響到出院時的生活品質。從2009年到2010年，總共有471個住院到高齡病房的病人參與這個研究。研究的工具使用周全性老年評估包含了日常生活活動功能評估（Activities of daily living; ADL）、老年憂鬱症量表（Geriatric depression scale; GDS）以及簡易智能量表（Mini-mental state examination; MMSE）。生活品質在病人出院時進行測量，採用European Quality of Life-5 Dimensions與European Quality of Life-5 Dimensions Visual Analog Scale 作為評估工具。病人住院的天數與Charlson comorbidity index 則是使用病歷回顧的方式進行記錄。統計方式包含了Chi-square test、independent t-test、Mann-Whitney U test與multiple linear regression。結果有憂鬱症狀的高齡病人，出院時容易合併較差的生活品質與更多的日常生活活動功能退化。憂鬱的症狀、女性、住院的天數、住院期間曾經接受過復健等因素，在線性回歸的模型中，都是顯著影響生活品質的重要因子。結論在高齡的住院病人中，我們不能忽視憂鬱症的存在，因為憂鬱症會造成生活品質的下降與併發症。我們應該更重視高齡住院病人可能的憂鬱症狀，並及早介入。除此之外，憂鬱症的介入不應只是在短期的住院治療中，因為憂鬱症可能延續到急性出院後。著眼於長期照顧體系的發展，更應該採用周全的評估方式，及早發現與治療老年期憂鬱症。 Background Late-life depression is common among elderly patients. Ignorance of the health problem, either because of under-diagnosis or under-treatment, causes additional medical cost and comorbidity. For a better health and quality of life (QoL), evaluation, prevention and treatment of late-life depression in elderly patients is essential. Methods This study examined (1) the differences of clinical characteristics, degree of improvement on QoL and functionality on discharge between non-depressed and depressed elderly inpatients, and (2) factors associated with QoL on discharge. Four hundred and seventy one elderly inpatients admitted to a geriatric evaluation and management unit (GEMU) from 2009 to 2010 were enrolled in this study. Comprehensive geriatric assessments including the activities of daily living (ADL), geriatric depression scale, and mini-mental state examination were conducted. QoL was assessed using the European Quality of Life-5 Dimensions and the European Quality of Life-5 Dimensions Visual Analog Scale on discharge. Information on hospital stay and Charlson comorbidity index were obtained by chart review. Chi-square tests, independent t-tests, Mann-Whitney U tests and multiple linear regressions were used in statistical analysis. Results Worse QoL and ADL on discharge were found among the depressed. Depressive symptoms, female gender, duration of hospital stay, and rehabilitation were significant factors affecting QoL on discharge in linear regression models. Conclusions The importance of diagnosis and treatment of depression among elderly inpatients should not be overlooked during hospital stay and after discharge. More efforts should be made to improve intervention for depressed elderly inpatients. Besides, we should keep following and helping them after discharge since depressive symptoms could remain for a long period of time. Along with the development of long-term care, more comprehensive assessment and should be applied for early diagnosis and intervention of late life depression.
顯示於類別:	[臨床醫學研究所] 博碩士論文

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