| 摘要: | 中高齡者罹病後返家期間的後續照護，涉及整合性照護服務中的過渡時期與轉介銜接兩個階段，而不同的照護流向，是否對其身體的狀況有不同的影響，乃是本研究所要探討的重點。
本研究以台灣南部某區域級醫院的出院病患為對象，並選定符合出院需後續照護的中高齡病患為樣本，進行為期六個月的觀察與追蹤調查，分別調查其出院後一週、一個月、三個月及六個月等四個時期中，曾接受過的醫療照護服務，並紀錄樣本個案在這段時間轉銜接受長期照護服務的情形。
研究結果顯示:(1) 在本研究追蹤的134個個案中,出院後照顧方式大多選擇返家由家人照顧（佔51.5％），再入院高峰期出現於出院後第一個月。(2)影響選擇不同照顧方式之相關因素包括被照顧者子女數、住院前居住狀況、出院當天ADLs與IADLs。(3)出院當天對輔具租借或購買需求與使用最多；出院後第一週、第一個月居家護理使用最多；第三個月則居家護理與居家服務使用同列最多；第六個月居家服務使用超越居家護理。(4)被照顧者『主要經濟來源』及『出院當天ADLs』與支持性服務使用有顯著之差異，其中主要經濟來源為『政府補助』者，使用支持性服務高於『自己工作收入或退休金存款』及『家人提供』；而出院當天ADLs『完全依賴』者使用也高於『嚴重依賴』者。(5)被照顧者ADLs完全依賴、IADLs障礙8項且罹患3種以上慢性疾病，有較高比率聘僱看護照顧及支持性服務使用。(6)ADLs中度依賴組(61-90分)有用輔具租借與購買者平均進步分數高於沒用者(29>10分)；而有用居家護理個案ADLs平均進步分數高於沒用者(50>26.18分)。(7)IADLs 8項障礙個案，使用送餐服務者IADLs平均進步
分數高於沒用者。
中高齡者就醫後身體活動功能將受影響，因此在出院後給予儘早介入適當的長期照護專業服務，有助於提升身體活動功能的恢復機會，減緩入住機構的時間。
The continuing care of post hospital has two parts, the transition stage and referral connection stage. Purpose of this study was in exploring the elder’s transitional care flow and the effects on their physical function status.
This research samples were the discharged patients from a district teaching hospital of Tainan area , and the middle-aged elders who needed to be continue care after discharge were selected. All samples were followed for six months, and investigated their medical care services use and the physical function change situation in the four time point, 1st week , 1st month,3rd months and 6th months of post hospital.
The results showed that : (1) most of the total 134 subjects were back home after discharge and taken care by their family (51.5%) , and the peak of re-admission in the first month among the period of post hospital , (2) the related factors of influence the selection of the way to take care of were subjects' children number, living conditions before hospitalization, the status of ADLs and IADLs in the discharge, (3) the most demand for the lease or purchase of assistive devices in the time of discharg, the most frequently use of home care was in the first weeks and the first months after discharge.The same utilization status of home care and home care services in 3th months of post hospital and then the home services exceeded among the 6th months, (4) the utilization of supportive services were significantly related to the main source of income and the ADLs status in discharge. The main income source come form the government’s grants had more use of the supportive services than the income from their own work pension or families, and the subjects were totally dependent level ADLs also more than lesser level, (5) the recipients of ADLs and IADLs totally dependence and with three or more chronic diseases had a higher percentage of employed nursing care and use supportive services, (6) ADLs moderate dependent group (61-90 points) with lease or purchase of assistive devices had the larger progress than useless (29> 10 points). The home care user’s ADLs score’s progress were more than useless (50> 26.18 points), (7) the subjects of IADLs totally dependent to use of meals service had more helpful than service useless.
The middle-aged elders have more chances to get diseases which could influence their physical activity. Based on the research result, We proposed to provide the appropriate care services for the post hospital patients as soon as possible to help improve their physical function and could be delay to reside in long- term care facilities. |
