INVESTIGATION OF OPTIMAL INTERVENTION FOR PREVENTING BED-RIDDEN STATE IN ELDERLY INPATIENTS

摘要本研究旨在探讨预防老年住院病人卧床状态的早期干预方案。在第一年的研究中，对老年住院患者下床的实际情况进行了调查。研究对象为4家医院住院的94名老年住院患者。我们调查了这些医院的实际时间安排和病人下床的方式以及在此期间发生的问题。我们进一步分析了阻碍患者下床的因素。根据本研究的结果，我们可以根据出院时的最终活动水平区分以下两组：康复组（N=63）达到了病前活动水平（独立行走），而恶化组（N=31）的活动水平低于病前水平。康复组下床的平均时间为8天，而病情恶化组下床的平均时间为14天。以下因素被确定为阻碍患者下床的因素：高龄、股骨骨折、心血管疾病、肌肉挛缩、痴呆和精神错乱。在第二年的研究中，我们调查了设备对病人下床的影响，提供了电动床和带扶手的移动厕所。虽然该设备有助于患者早日下床，但为了防止卧床不起，应该考虑包括混乱状态管理等其他因素在内的更全面的对策。建议采取以下措施促进患者下床：1)为防止活动能力恶化，卧床时间应保持在两周以内；2)在确定的阻碍患者下床的因素中，患者处于混乱状态，可以通过熟练的护理来管理。应探索不采用身体约束或药物等措施来管理混乱状态。根据两年的调查结果，我们提出了预防老年人卧床状态的干预指南。少

The purpose of this study is to develop an early intervention program for preventing bed-ridden state in elderly patients undergoing medical treatment. An investigation of the actual situation of getting out of bed in elderly inpatients was undertaken in the first year research. The subjects were 94 elderly inpatients hospitalized in 4 hospitals.We investigated the actual time schedule and the approach to get the patients out of their beds in these hospitals and the problems that occur during theses period. We further analyzed the factors that have impeded the patienta to get out of their beds.As a results of this investigation, we could distinguish the following two groups in terms of ultimate mobility level at the time of discharge : the recocvered group(N=63)whice attained the premorbid level of mobility(independent ambulation)and the deteriorated group(N=31)which demonstrated lower mobility compared to the premorbidlevel. The mean time period for the recovered group to get out of t … More heir beds was 8days, while the deteriorated group took 14 days to get out of their beds. The following factors were identified that impeded the patients to get out of their beds : advanced age, fracture of the femur, CVD,muscle contracture, dementia and confused sate.For the second year research, we investigated the effects of equipment on the patients' getting out of their beds providing electromotive-powered beds and portable toilets with handrails. Although the equipment helped the patients getting out of their beds earlier, it was suggested that a more comprehensive countermeasure that encompass other factors such as management of confused state should be considered in order to prevent bed-ridden state.The following were suggested as the measures to facilitate the patients'getting out of their beds : 1)in order to prevent the deterioration of mobility, the bed-ridden period should be kept less than two weeks, 2)out of the factors identified to impede the patients'getting out of their beds was confused state which could be managed by skilled nursing care. Management of confused state without resorting to such measures as physical restrain or medication shoule be explored.Based upon the results of two-year investigation, we proposed a guideline of intervention for the prevention of bed-ridden state in the elderly. Less