老年脑卒中患者护理依赖现状调查
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摘要
目的调查老年脑卒中患者护理依赖的发生现状并分析其影响因素。方法采取便利抽样法,于2017年4月—11月选取北京市某三级甲等医院神经内科病房、综合科病房的老年脑卒中患者共262例,采用自行设计的一般资料调查表收集患者的人口学资料和疾病相关资料,采用护理依赖量表、简易智能精神状态检查量表、微营养评定法简表、老年抑郁量表测量老年脑卒中患者的护理依赖程度及相关因素。采用二分类Logistic回归方程探讨影响老年脑卒中患者护理依赖的因素。结果调查对象的护理依赖评分为(56.04±10.53)分,护理依赖的发生率为80.5%;多因素回归分析结果显示,年龄、最近1年有无跌倒史、是否留有肢体功能障碍、患慢性疾病数量、抑郁状态、营养状态及有无认知功能障碍是老年脑卒中患者护理依赖的影响因素(P<0.05)。结论老年脑卒中患者护理依赖的发生率高,护士在临床护理过程中应重点关注高龄、有跌倒史、留有肢体功能障碍、共病状态、抑郁状态、营养状态异常及有认知功能障碍的患者,并采取积极有效的干预措施,减少因护理依赖导致的患者生活质量下降。
Objective To describe the level of care dependency among elderly stroke patients and to explore the influencing factors. Methods From April 2017 to November 2017,totally 262 elderly stroke patients in the neurology ward and general medicine ward of a tertiary hospital in Beijing were selected. A self-designed general information questionnaire was used to collect patients' demographic data and disease related data. Care Dependency Scale,Mini-Mental State Examination,Mini Nutritional Assessment-short form and Geriatric Depression Scale were used to measure care dependency and influencing factors. Binary logistic regression analysis was used to investigate the influencing factors. Results Among 262 elderly stroke patients,the score of care dependency was(56.04 ±10.531),the incidence of care dependency was 80.5%. Multivariate regression analysis showed that:age,history of fall within one year,limb dysfunction,number of chronic diseases,depression,nutritional status and cognitive function state were the influencing factors(P<0.05). Conclusion The incidence of care dependency in elderly stroke patients was high,which was related to age,history of fall,limb dysfunction,comorbidity,depression status,abnormal nutritional status and cognitive function. It suggests that nurses should take active and effective measures to reduce quality of life decreasing due to care dependency.
Objective To describe the level of care dependency among elderly stroke patients and to explore the influencing factors. Methods From April 2017 to November 2017,totally 262 elderly stroke patients in the neurology ward and general medicine ward of a tertiary hospital in Beijing were selected. A self-designed general information questionnaire was used to collect patients' demographic data and disease related data. Care Dependency Scale,Mini-Mental State Examination,Mini Nutritional Assessment-short form and Geriatric Depression Scale were used to measure care dependency and influencing factors. Binary logistic regression analysis was used to investigate the influencing factors. Results Among 262 elderly stroke patients,the score of care dependency was(56.04 ±10.531),the incidence of care dependency was 80.5%. Multivariate regression analysis showed that:age,history of fall within one year,limb dysfunction,number of chronic diseases,depression,nutritional status and cognitive function state were the influencing factors(P<0.05). Conclusion The incidence of care dependency in elderly stroke patients was high,which was related to age,history of fall,limb dysfunction,comorbidity,depression status,abnormal nutritional status and cognitive function. It suggests that nurses should take active and effective measures to reduce quality of life decreasing due to care dependency.
引文
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[6]全国第四届脑血管病学术会议.各类脑血管病诊断要点[J].中华神经杂志,1996,29:379-380.
[7] Dijkstra A,Buist G,Dassen T. Nursing-care dependency. Development of an assessment scale for demented and mentally handicapped patients[J]. Scand J Caring Sci,1996,10(3):137-143.
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[11]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.
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[13]何扬利,蹇在金,欧阳敏,等. MNA和MNA-SF评价老年人营养状况比较[J].实用老年医学,2004(5):243-245.
[14] Fol stein MF,Folstein SE,Mchugh PR.“Mini-mental state”:a practical method for grading the cognitive state of patients for the clinician[J]. J Psychiatr Res,1975,12(3):189-198.
[15] Katzman R,Zhang MY,Ouang YQ,et al. A Chinese version of the Mini-Mental State Examination; impact of illiteracy in a Shanghai dementia survey[J]. J Clin Epidemiol,1988,41(10):971-978.
[16]喻秀芬,朱文芳.脑卒中出院患者护理依赖性评估与分析现状[J].齐鲁护理杂志,2018,24(1):36-39.
[17]徐秀萍,吴凌云,王秀丽,等.衢州市老年住院患者衰综合征评估及照护依赖状况研究[J].医学与社会,2017,30(8):64-66.
[18] Muszalik M,Kornatowski T,Zielinska-WieczkowskaH,et al. Functional assessment of geriatric patients in regard to health—related quality of life(HRQoL)[J]. Clinical Interv Aging,2014,10:61-67.
[19]薛阳阳.中文版照护依赖量表的构建及在老年人衰弱研究中的初步应用[D].温州:温州医科大学,2015:52-53.
[20] Schnitzer S,vond dem knesebeck O,Kohler M,et al. How does age affect the care dependency risk one year after stroke?A study based on claims date from a German health insurance fund[J]. BMC Geratr,2015,15:135.
[21] Koller D,Sch觟n G,Sch覿fer I,et al. Multimorbidity and longterm care dependency-a five-year follow-up[J]. BMC Geriatr,2014,14:70.
[22]祁华金.中国农村老年人慢病情况及其对日常生活能力的影响研究[D].济南:山东大学,2014:54-55.
[23]张可可.北京部分社区老年人慢病及老年综合征的调查分析[D].北京:北京协和医学院,2016:35-36.
[24]贾欣欣.老年人群健康状况及其影响因素研究[D].南京:南京医科大学,2016:42-43.
[25] Murphy J,Isaacs B. The post-fall syndrome. A study of 36ederly patients[J]. Gerontology,1982,28(4):265-270.
[26]司惠芳,梁岚萍,刘向真,等.脑卒中肢体功能康复现状综述[J].中华护理杂志,2004,39(7):58-61.
[27] Chemerinski E,Robinson RG,Kosier JT. Improved recovery in activities of daily living associated with remission of poststroke depression[J]. Stroke,2001,32(2):113-117.
[28]刘永珍,于逢春,尹静,等.脑卒中后抑郁状态对预后的影响:7年随访[J].中国神经精神疾病杂志,2010,36(5):292-295.
[29]徐江华.中风患者出院前自我管理效能感现状及影响因素研究[D].武汉:湖北中医药大学,2013:45-46.
[30] FOOD Trial Collaboration. Poor nutritional status on admission predicts poor outcomes after stroke:observational data from the FOOD trial[J]. Stroke,2003,34(6):1450-1456.
[31] Shigaki CL,Frey SH,Barrett AM. Rehabilitation of post-stroke cognition[J]. Semin Neurol,2014,34(5):496-503.
[32]古楚儿,彭刚艺,应文娟,等.老年脑梗死患者社会化住院现状及影响因素分析[J].中华护理杂志,2019,54(2):194-198.
[33]吕姣.老年卒中后认知障碍患者的日常生活能力现况调查[J].中国老年保健医学,2016,14(4):71-72.
[34]谷丽娟,杨水琴,周亚芬.集中健康训练结合回授法认知干预在老年轻度认知功能障碍患者中的应用效果[J].中华护理教育,2018,15(11):836-839.
[35]田家利,刘宇,张素,等.家庭护理评估量表的汉化和信效度检验[J].中华护理杂志,2019,54(2):199-205.
[2]王陇德.中国脑卒中防治报告(2016)[M].北京:人民卫生出版社,2016.
[3]王秋玲.缺血性脑卒中患者疾病不确定感与自我护理能力相关性研究[D].长春:吉林大学,2016:9-10.
[4]李泉慧,陈长英,魏璐.住院老年病人健康相关生活质量与护理依赖的相关性研究[J].全科护理,2017,15(24):2953-2955.
[5] Caljouw MA,Cools HJ,Gussekloo J. Natural course of care dependency in resident of long-term care facilities:prospective follow-up study[J]. BMC Geriatr,2014,14:67.
[6]全国第四届脑血管病学术会议.各类脑血管病诊断要点[J].中华神经杂志,1996,29:379-380.
[7] Dijkstra A,Buist G,Dassen T. Nursing-care dependency. Development of an assessment scale for demented and mentally handicapped patients[J]. Scand J Caring Sci,1996,10(3):137-143.
[8] Dijkstra A,Yont GH,Korhan A,et al. The Care Dependency Scale for measuring basic human needs:an international comparison[J]. J Adv Nurs,2012,68(10):2341-2348.
[9]章舒琦,朱月妹,李丽,等.中文版护理依赖量表用于老年患者的信效度分析[J].护理学杂志,2014,29(3):7-9.
[10] Brink TL,Yesavage JA,Lum O,et al. Screening test for geriatric depression[J]. Clinical Gerontologist,1982,1(1):37-43.
[11]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.
[12] Guigoz Y,Vellas B,Garry PJ. Assessing the nutritional status of the elderly:the mini nutritional assessment as part of the geriatric evaluation[J]. Nutr Rev,1996,54(1Pt 2):S59.
[13]何扬利,蹇在金,欧阳敏,等. MNA和MNA-SF评价老年人营养状况比较[J].实用老年医学,2004(5):243-245.
[14] Fol stein MF,Folstein SE,Mchugh PR.“Mini-mental state”:a practical method for grading the cognitive state of patients for the clinician[J]. J Psychiatr Res,1975,12(3):189-198.
[15] Katzman R,Zhang MY,Ouang YQ,et al. A Chinese version of the Mini-Mental State Examination; impact of illiteracy in a Shanghai dementia survey[J]. J Clin Epidemiol,1988,41(10):971-978.
[16]喻秀芬,朱文芳.脑卒中出院患者护理依赖性评估与分析现状[J].齐鲁护理杂志,2018,24(1):36-39.
[17]徐秀萍,吴凌云,王秀丽,等.衢州市老年住院患者衰综合征评估及照护依赖状况研究[J].医学与社会,2017,30(8):64-66.
[18] Muszalik M,Kornatowski T,Zielinska-WieczkowskaH,et al. Functional assessment of geriatric patients in regard to health—related quality of life(HRQoL)[J]. Clinical Interv Aging,2014,10:61-67.
[19]薛阳阳.中文版照护依赖量表的构建及在老年人衰弱研究中的初步应用[D].温州:温州医科大学,2015:52-53.
[20] Schnitzer S,vond dem knesebeck O,Kohler M,et al. How does age affect the care dependency risk one year after stroke?A study based on claims date from a German health insurance fund[J]. BMC Geratr,2015,15:135.
[21] Koller D,Sch觟n G,Sch覿fer I,et al. Multimorbidity and longterm care dependency-a five-year follow-up[J]. BMC Geriatr,2014,14:70.
[22]祁华金.中国农村老年人慢病情况及其对日常生活能力的影响研究[D].济南:山东大学,2014:54-55.
[23]张可可.北京部分社区老年人慢病及老年综合征的调查分析[D].北京:北京协和医学院,2016:35-36.
[24]贾欣欣.老年人群健康状况及其影响因素研究[D].南京:南京医科大学,2016:42-43.
[25] Murphy J,Isaacs B. The post-fall syndrome. A study of 36ederly patients[J]. Gerontology,1982,28(4):265-270.
[26]司惠芳,梁岚萍,刘向真,等.脑卒中肢体功能康复现状综述[J].中华护理杂志,2004,39(7):58-61.
[27] Chemerinski E,Robinson RG,Kosier JT. Improved recovery in activities of daily living associated with remission of poststroke depression[J]. Stroke,2001,32(2):113-117.
[28]刘永珍,于逢春,尹静,等.脑卒中后抑郁状态对预后的影响:7年随访[J].中国神经精神疾病杂志,2010,36(5):292-295.
[29]徐江华.中风患者出院前自我管理效能感现状及影响因素研究[D].武汉:湖北中医药大学,2013:45-46.
[30] FOOD Trial Collaboration. Poor nutritional status on admission predicts poor outcomes after stroke:observational data from the FOOD trial[J]. Stroke,2003,34(6):1450-1456.
[31] Shigaki CL,Frey SH,Barrett AM. Rehabilitation of post-stroke cognition[J]. Semin Neurol,2014,34(5):496-503.
[32]古楚儿,彭刚艺,应文娟,等.老年脑梗死患者社会化住院现状及影响因素分析[J].中华护理杂志,2019,54(2):194-198.
[33]吕姣.老年卒中后认知障碍患者的日常生活能力现况调查[J].中国老年保健医学,2016,14(4):71-72.
[34]谷丽娟,杨水琴,周亚芬.集中健康训练结合回授法认知干预在老年轻度认知功能障碍患者中的应用效果[J].中华护理教育,2018,15(11):836-839.
[35]田家利,刘宇,张素,等.家庭护理评估量表的汉化和信效度检验[J].中华护理杂志,2019,54(2):199-205.