Development and clinical application of new assessment tool to measure QOL of elderly wit severe functional disability

如何保持高质量的护理是老年人长期护理的一个重要主题。然而，评估工具来衡量老年痴呆症患者的生活质量是不可用的。因此，本研究的目的是评价本课题组编制的活力指数的实用效度，以及该指数是否能作为一个新的量表用于评估老年痴呆患者的生活质量。首先，在多个不同功能的病房同时测定ADL和活力指数。内科治疗性病房活力指数平均分下降。在痴呆单元中，活力指数从满分到零分布。第二，分别测量康复前后Barthel指数、N-ADL、NM、SDS、HDSR、Vitality指数等量表的变化。第三，探讨生命力指数与长期照护保险照护等级的关系。第四，探讨长期照护机构生命力指数得分的自然结果。生命力指数在长期照护机构的六个月内没有显著变化。最后，我们评估哪些因素与长期照护机构的存活率有关。多元验证分析表明，只有性别（女性）和活力指数得分高是影响老年痴呆患者生存的重要因素，活力指数是一种新的评估老年痴呆患者的实用工具。

One of the most essential theme in long- term care for elderly is how to keep high quality care. However, assessment tool to measure QOL of elderly subjects with dementia is not available. Therefore, the purpose of the present study is to evaluate the practical validity of Vitality Index developed by our group, whether the index will be a new scale to assess QOL of elderly subjects with dementia. We performed several projects to complete the purpose.First, ADL and Vitality index were simultaneously measured in several wards with different function. In medical therapeutic ward, average score of Vitality index was decreased. In dementia unit, Vitality index was distributed from full score to zero. On the other hand, Vitality was well reserved in nursing unit.Second, we measured the chancy in several scales including Barthel Index, N- ADL, NM, SDS, HDSR and Vitality index before and after group rehabilitation. Only SDS and Vitality index were significantly changed.Third, relationship between Vitality Index and care rank of long-term care insurance was examined. Vitality index was negatively correlated with care rank.Forth, natural consequence of score of Vitality index was measured in long-term care facility. Vitality index was not significantly changed for 6 month in long-term care facility.Finally, we evaluated which factors are involved in survival in long-term care facility. Only sex (female) and high score of Vitality Index were significant factors for survival by the multi- validate analysis.In conclusion, Vitality Index is a new useful practical tool to assess elderly with dementia.