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

本研究目的在探讨早期介入方案，以预防老年病患在接受内科治疗时出现卧床不起的情形。在第一年的研究中，对老年住院病人的实际下床情况进行了调查。以4所医院94例老年住院患者为研究对象，调查了这些医院的实际下床时间安排、下床方式以及在下床期间出现的问题。我们进一步分析了阻碍患者下床活动的因素，根据调查结果，我们可以区分以下两组出院时的最终活动水平：恢复组（N=63）达到了病前的活动水平（独立活动），恶化组（N=31）与病前水平相比，表现出较低的活动水平。恢复组的平均时间从t ...更多信息 病情恶化组下床活动时间为14天，病情恶化组下床活动时间为8天。研究发现高龄、股骨骨折、心血管疾病、肌肉挛缩、痴呆和意识模糊是影响患者下床活动的主要因素。在第二年的研究中，我们调查了提供电动床和带扶手的便携式厕所的设备对患者下床活动的影响。虽然这些设备帮助病人更早地下床活动，但建议应考虑更全面的对策，包括其他因素，如管理混乱状态，以防止卧床不起。建议采取以下措施，以促进病人下床活动：（1）为防止活动能力的恶化，卧床时间应控制在2周以内;（2）影响患者下床活动的因素中，意识模糊状态可通过熟练的护理加以处理。本文根据两年的调查结果，提出了预防老年人卧床不起的干预措施。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