综合康复护理对老年卧床患者日常生活能力及抑郁症状的影响
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摘要
目的 探讨综合康复护理对老年卧床患者日常生活活动能力及抑郁症状的应用效果。方法 选取2018年6-9月在乌鲁木齐市养老福利院居住的128例老年卧床患者,根据卧床不起诊断标准将其分为A、B、C三个等级,将不同卧床级别的患者随机分为观察组和对照组。对照组给予常规治疗和护理,观察组在对照组的基础上实施综合康复护理干预,在干预前和干预之后的8周,通过Barthel指数和老年抑郁量表(Geriatric Depression Scale-30,GDS-30)来评估日常生活能力和抑郁症状。结果 干预前各等级的对照组、观察组患者日常生活能力(activities of daily living,ADL)评分、GDS评分差异无统计学意义(P>0.05)。干预后8周,A、B、C卧床级别的观察组患者Barthel指数评定量表(Barthel Index,BI)ADL评分显著上升[A级:(68.70±5.68)vs.(83.69±8.29),t=11.247,P<0.001;B级:(52.50±5.26)vs.(74.75±9.39),t=15.112,P<0.001; C级:(31.36±5.81)vs.(34.32±5.19),t=2.891,P=0.009],GDS评分显著下降[A级:(13.39±4.08)vs.(10.04±4.33),t=-3.076,P=0.006;B级:(15.51±4.83)vs.(11.90±4.29),t=-5.190,P<0.001; C级:(18.23±4.93)vs.(14.50±5.46),t=-3.582,P=0.002],差异均有统计学意义(P<0.05);各级对照组干预前后ADL评分[A级:(68.81±6.51)vs.(70.00±7.07),t=1.588,P=0.135;B级:(53.64±4.92)vs.(55.45±5.96),t=1.789,P=0.088; C级:(30.75±5.45)vs.(31.25±4.55),t=0.567,P=0.577]、GDS评分[A级:(13.52±4.78)vs.(13.10±4.39),t=-1.752,P=0.095;B级:(16.36±5.20)vs.(15.14±5.15),t=-1.618,P=0.121; C级:(19.10±5.95)vs.(19.30±6.03),t=1.453,P=0.163],差异均无统计学意义(P>0.05)。干预后不同卧床级别观察组患者上述指标均显著优于对照组同期的评估结果,差异有统计学意义(P<0.05)。结论 综合康复护理能够提高老年卧床患者的日常生活能力,延缓卧床不起的进程,减轻抑郁情绪。
Objective To explore the application effect of integrated rehabilitation nursing on improving the ability of activity of daily living and depressive symptoms of elderly bedridden patients. Methods A total of 128 elderly bedridden patients who were selected from a geracomium in Urumqi in June-September, 2018 were randomly divided into three grades(A, B and C) according to the bedridden diagnostic criteria. Patients with different bedridden grades were randomly divided into the observation groups and the control groups. The control groups were given conventional treatment and nursing, while the observation groups received integrated rehabilitation nursing intervention on the basis of the control groups. Before and 8 weeks after the intervention, we gathered general information and evaluated activities of daily living(ADL) by Barthel index and depressive symptoms by Geriatric Depression Scale-30(GDS-30). Results No statistically significant differences were found in the scores of ADL and GDS between the control groups and the observation groups before the intervention(P>0.05). 8 weeks after the intervention, the scores of ADL in patients with bedridden grades A, B and C in the observation groups significantly increased(grade A:(68.70±5.68) vs.( 83.69±8.29),t= 11.247,P<0.001; grade B:( 52.50±5.26) vs.( 74.75±9.39),t = 15.112,P<0.001; grade C:( 31.36±5. 81) vs.( 34.32±5.19),t = 2.891,P = 0.009),while the scores of GDS significantly decreased( grade A:( 13.39± 4.08) vs.( 10.04±4.33),t=-3.076,P= 0.006; grade B:( 15.51±4.83) vs.( 11.90±4.29),t =-5.190,P<0.001; grade C:( 18.23±4. 93) vs.( 14.50±5.46),t =-3.582,P = 0.009),showing statistically significant differences( all P<0.05). Before and 8 weeks after the intervention,the scores of ADL and GDS in patients with bedridden grades A,B and C in the control groups were as follows: grade A:(( 68.81±6.51) vs.( 70.00±7.07),t = 1.588,P = 0.135)) and(( 13.52±4.78) vs.( 13.10±4.39),t =-1.752,P = 0. 095)); grade B:(( 53.64±4.92) vs.( 55.45±5.96),t = 1.789,P = 0.088)) and(( 16.36±5.20) vs.( 15.14±5.15),t =-1.618,P = 0.121)),and grade C:(( 30. 75 ± 5. 45) vs.( 31. 25 ± 4. 55),t = 0. 567,P = 0. 577)) and(( 19. 10 ± 5. 95) vs.( 19.30±6.03),t= 1.453,P= 0.163)),without statistically significant differences( all P>0.05). 8 weeks after the intervention,the above-mentioned indicators in patients with bedridden grades A,B and C in the observation groups were significantly superior to those in the control group,with statistically significant differences( all P < 0. 05). Conclusions Integrated rehabilitation nursing can improve elderly bedridden patients' ability in activity of daily living,delay the bedridden process,and reduce the depression.
Objective To explore the application effect of integrated rehabilitation nursing on improving the ability of activity of daily living and depressive symptoms of elderly bedridden patients. Methods A total of 128 elderly bedridden patients who were selected from a geracomium in Urumqi in June-September, 2018 were randomly divided into three grades(A, B and C) according to the bedridden diagnostic criteria. Patients with different bedridden grades were randomly divided into the observation groups and the control groups. The control groups were given conventional treatment and nursing, while the observation groups received integrated rehabilitation nursing intervention on the basis of the control groups. Before and 8 weeks after the intervention, we gathered general information and evaluated activities of daily living(ADL) by Barthel index and depressive symptoms by Geriatric Depression Scale-30(GDS-30). Results No statistically significant differences were found in the scores of ADL and GDS between the control groups and the observation groups before the intervention(P>0.05). 8 weeks after the intervention, the scores of ADL in patients with bedridden grades A, B and C in the observation groups significantly increased(grade A:(68.70±5.68) vs.( 83.69±8.29),t= 11.247,P<0.001; grade B:( 52.50±5.26) vs.( 74.75±9.39),t = 15.112,P<0.001; grade C:( 31.36±5. 81) vs.( 34.32±5.19),t = 2.891,P = 0.009),while the scores of GDS significantly decreased( grade A:( 13.39± 4.08) vs.( 10.04±4.33),t=-3.076,P= 0.006; grade B:( 15.51±4.83) vs.( 11.90±4.29),t =-5.190,P<0.001; grade C:( 18.23±4. 93) vs.( 14.50±5.46),t =-3.582,P = 0.009),showing statistically significant differences( all P<0.05). Before and 8 weeks after the intervention,the scores of ADL and GDS in patients with bedridden grades A,B and C in the control groups were as follows: grade A:(( 68.81±6.51) vs.( 70.00±7.07),t = 1.588,P = 0.135)) and(( 13.52±4.78) vs.( 13.10±4.39),t =-1.752,P = 0. 095)); grade B:(( 53.64±4.92) vs.( 55.45±5.96),t = 1.789,P = 0.088)) and(( 16.36±5.20) vs.( 15.14±5.15),t =-1.618,P = 0.121)),and grade C:(( 30. 75 ± 5. 45) vs.( 31. 25 ± 4. 55),t = 0. 567,P = 0. 577)) and(( 19. 10 ± 5. 95) vs.( 19.30±6.03),t= 1.453,P= 0.163)),without statistically significant differences( all P>0.05). 8 weeks after the intervention,the above-mentioned indicators in patients with bedridden grades A,B and C in the observation groups were significantly superior to those in the control group,with statistically significant differences( all P < 0. 05). Conclusions Integrated rehabilitation nursing can improve elderly bedridden patients' ability in activity of daily living,delay the bedridden process,and reduce the depression.
引文
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[14] 吴义姣,张天娇,郝无迪,等.2013年沈阳市农村老年人抑郁症状现状及其影响因素分析[J].实用预防医学,2018,25(7):773-776.
[15] 徐永能,卢少萍,林建华,等.群组管理对出院后居家老年卧床病人日常生活能力及负性情绪的影响[J].护理研究,2014,28(34):4244-4247.
[16] Pendergast DR,Fisher NM,Calkins E.Cardiovascular,neuromuscular and metabolic alterations with age leading to frailty[J].J Gerontol,1993,48(Spec Iss):61-67.
[17] Hirakawa Y,Masuda Y,Kimata T,et al.Effects of home massage rehabilitation therapy for the bed-ridden elderly:a pilot trial with a three-month follow-up[J].Clin Rehabil,2005,19(1):20-27.
[18] 陈雪丽,刘玉湖.综合康复治疗防治老年卧床不起及其并发症的疗效[J].中国康复理论与实践,2011,17(8):767-769.
[19] 倪洁,钱蕾,曹丽娟,等.跨理论模式的健康教育对老年卧床不起患者自理能力的影响[J].国际护理学杂志,2015,(18):2524-2527.
[20] 王芳,徐卿,蒋骏,等.早期综合康复护理对脑卒中患者日常生活活动能力和运动功能的影响分析[J].河北医药,2018,40(15):2398-2400.
[21] 林裕子.開·閉眼状態の姿勢変化が脳活動におよぼす影響[J].日本脳神経看護研究学会誌,2009,31(2):109-116.
[22] van Walraven C,Oake N,Jennings A,et al.The association between continuity of care and outcomes comes:a systematic and critical review[J].J Eval Clin Pract,2010,16(5):947-956.
[23] Robinson RG,Spalletta G.Poststroke depression:a review[J].Can J Psychiatry,2010,55(6):341-349.
[2] Diener E,Suh EM,Lucas RE,et al.Subjective well-being:three decades of progress[J].Psychol Bull,1999,125(2):276-302.
[3] 陈茜,许丽,叶敏,等.成都市卧床老年人的抑郁及其相关因素调查分析[J].华西医学,2013,28(8):1253-1256.
[4] 陈雪丽,刘玉湖.综合康复治疗防治老年卧床不起及其并发症的疗效[J].中国康复理论与实践,2011,17(8):767-769.
[5] 帕丽达·买买提,武云云,茹克亚古丽·买买提,等.综合康复护理干预对废用综合征患者的效果评价[J].中国康复医学杂志,2018,33(3):340-342.
[6] 中岛纪惠子.老年看护学[M].东京:医学书院,1998:322.
[7] 井口昭久.老年学[M].名古屋:名古屋大学出版社,2008:71.
[8] 紙屋克子,柏木とき江,原川静子,等.遷延性意識障害患者の看護プログラムの開発(第1報)温浴と微振動等による拘縮の解除[J].日本医療マネジメント学会雑誌,2007,8(1):231.
[9] 紙屋克子.ナ-シングバイオメカニクスに基づく自立のための生活支援技術(第三版)[M].东京:株式会社ナ-シングサイエンスアカデミ-出版社,2010:7-131.
[10] Mahoney FI,Barthel DW.Functional evalution:the Barthel index[J].Md State Med J,1965,14:61-65.
[11] Lee YC,Chen SS,Koh CL,et al.Development of two Barthel index based supplementary scales for patients with stroke[J].PLoS One,2014,9(10):e110494.
[12] 刘杰,王瑛,王晓慧,等.中文版老年抑郁量表在城市社区老年人群中应用的信效度研究[J].中国临床心理学杂志,2013,21(1):39-41.
[13] 王长虹,杨秋霞,王永红,等.邢台市养老机构入住人员慢性病患病情况调查[J].实用预防医学,2018,25(8):925-928.
[14] 吴义姣,张天娇,郝无迪,等.2013年沈阳市农村老年人抑郁症状现状及其影响因素分析[J].实用预防医学,2018,25(7):773-776.
[15] 徐永能,卢少萍,林建华,等.群组管理对出院后居家老年卧床病人日常生活能力及负性情绪的影响[J].护理研究,2014,28(34):4244-4247.
[16] Pendergast DR,Fisher NM,Calkins E.Cardiovascular,neuromuscular and metabolic alterations with age leading to frailty[J].J Gerontol,1993,48(Spec Iss):61-67.
[17] Hirakawa Y,Masuda Y,Kimata T,et al.Effects of home massage rehabilitation therapy for the bed-ridden elderly:a pilot trial with a three-month follow-up[J].Clin Rehabil,2005,19(1):20-27.
[18] 陈雪丽,刘玉湖.综合康复治疗防治老年卧床不起及其并发症的疗效[J].中国康复理论与实践,2011,17(8):767-769.
[19] 倪洁,钱蕾,曹丽娟,等.跨理论模式的健康教育对老年卧床不起患者自理能力的影响[J].国际护理学杂志,2015,(18):2524-2527.
[20] 王芳,徐卿,蒋骏,等.早期综合康复护理对脑卒中患者日常生活活动能力和运动功能的影响分析[J].河北医药,2018,40(15):2398-2400.
[21] 林裕子.開·閉眼状態の姿勢変化が脳活動におよぼす影響[J].日本脳神経看護研究学会誌,2009,31(2):109-116.
[22] van Walraven C,Oake N,Jennings A,et al.The association between continuity of care and outcomes comes:a systematic and critical review[J].J Eval Clin Pract,2010,16(5):947-956.
[23] Robinson RG,Spalletta G.Poststroke depression:a review[J].Can J Psychiatry,2010,55(6):341-349.
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