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

本研究的目的是制定一套预防老年患者卧床状态的早期干预方案。第一年对住院老年患者下床的实际情况进行调查。以4家医院94例老年住院患者为研究对象，调查了这些医院的实际时间安排和患者下床的方法，以及在这些时间段内出现的问题。我们进一步分析了阻碍患者下床的因素。作为本次调查的结果，我们可以根据出院时的最终活动水平来区分以下两组：恢复组(N=63)达到病前的活动水平(独立行走)和恶化组(N=31)的活动程度低于病前水平。恢复组退出t…的平均时间段更多的继承人需要8天的时间，而恶化的一组需要14天才能下床。发现阻碍患者下床的因素如下：高龄、股骨骨折、心血管疾病、肌肉痉挛、痴呆和状态混乱。在第二年的研究中，我们调查了设备对患者下床的影响，提供电动床和带扶手的移动厕所。虽然卧床时间较早，但应综合考虑混乱状态管理等因素，以预防卧床状态的发生。建议采取以下措施：1)为防止患者活动能力的恶化，卧床时间应控制在2周以内；2)在已发现的阻碍患者下床的因素中，应排除混乱状态，并可通过熟练的护理加以管理。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。较少

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