臺灣博碩士論文加值系統

背景與目的：台灣地區老年人口不斷增加，由於生理衰退與社會適應障礙，有愈來愈高比例的老年人產生憂鬱的情況。而憂鬱情形會與老年人的功能表現互相影響，一旦老年人身心衰退過於嚴重，便會產生失能的情況。屆時，不僅增加了醫療費用的支出，也提高了日常生活照護上人力資源的消耗。因此，本研究旨在探討社區老年人的憂鬱傾向與其身體功能的相關性；並進行一年的追蹤，觀察社區老年人其憂鬱傾向和身體功能（包含肌力、行走速度、耐力和平衡）改變的相關性。
方法：本研究共收取191位社區居住且具有獨立行走能力（可使用行走輔具）的老年人，經填寫同意書、基本資料、簡易老年憂鬱量表、簡易智能量表的面對面訪談和填答，及給予身體功能的檢測。於一年後，邀約所有受試者再重複一次同樣的檢測流程。統計方法為使用相關性分析和羅吉斯迴歸分析法來分析單一時間點憂鬱傾向與身體功能的相關；一年期追蹤結果則以重複測量共變數分析探討不同憂鬱發展組別其身體功能表現的變化。
結果：本研究中，老年人憂鬱傾向盛行率為23.6%。單一時間點身體功能中的三十秒坐站測試、六分鐘行走測試、閉眼單足立測試以及計時起走測試(rho= -.221、-.224、-.178、.222, p皆小於.05)與老年憂鬱傾向有顯著相關；然而經迴歸分析後，只有六分鐘行走測試(HR=.994,Wald=4.465, p<.05)為顯著相關因子。接著，再經基本人口學因子調整後，顯著相關因子則為有無規律運動習慣與自覺健康狀態(HR=5.902、3.855, Wald=13.160、9.226, p皆小於.05)。一年期研究結果顯示，不同憂鬱傾向發展的老年人其計時起走達顯著差異(F值=2.734，p=.045)，不同憂鬱傾向發展組別與其前後測在六分鐘行走測試項目上達顯著交互作用(F值=2.889，p=.037)，不同憂鬱傾向發展的老年人其三十秒坐站達顯著差異(F值=3.921，p=.010)，其前後測也有顯著差異(F值=5.237，p=.023)。
結論：橫斷面而言，規律運動習慣與自覺健康狀態比起身體功能表現更能夠預測憂鬱傾向。一年期資料分析結果顯示，憂鬱傾向的變化，會顯著影響下肢的功能表現，而非上肢肌力和平衡能力。產生憂鬱傾向者，其下肢功能表現變差；而當憂鬱傾向緩解，則會增進其下肢功能表現。

Background and purpose：The population of the elderly in Taiwan increases rapidly. Because of the physical decline and the barriers of the social adaption, more and more elderly have depressive symptoms. Interactively, depressive symptoms affect the physical function of the elderly as well. As the physical function of the elderly seriously declines or major depression developed in them, consequently, disability will usually be resulted. This will not only greatly increase the medical expenses, but also the needs of long-term care manpower, therefore, result in heavy burden on the family and society. The purposes of the study are to investigate the relationships between the depressive symptoms and the physical function (strength, speed, endurance, and balance) in the community-dwelling elderly in Taiwan, and to investigate the impact of changes in the physical function on the depressive symptoms over a 1-year-period.
Methods：One hundred ninty one volunteered community dwelling older adults who can walk independently (including walking with devices) were recruited into this study. After signing the consent form, each subject accept face-to-face interview and self-report for basic data. Geriatric Depressive Scale – Short Form 15(GDS-SF15) and Mini-mental state examination (MMSE) were assessed. Physical function tests were evaluated. The whole procedures were repeated again at follow-up in 1 year later.
Results：Prevalence of depressive symptom in the study population is 23.9%. At baseline, the functional performance of TUG, Six-MWT, 30s-STS and OLS were significantly correlated with depressive symptoms (rho=-.221, -.224, -.178, .222, p<.05, respectively) in univariate analyses. In multivariate analysis, only the association of Six-MWT and depressive symptoms remained significant (HR=.994, Wald=4.465, p<.05). However, with adjustment, without regular exercise and poor self-reported health status became significantly correlated with depressive symptoms (HR=5.902, 3.855, Wald=13.160, 9.226, p<.05, respectively) cross-sectionally. The longitudinal data showed significant difference of the TUG between different depressive groups (F=2.734, p=.045).There is an interaction between different depressive groups and time (F=2.889, p=.037) in the Six-MWT. 30s-STS showed significant differences between different depressive groups (F=3.921, p=.010), and between pre-post tests (F=5.237, p=.023).
Conclusion： In our study population, health and exercise status were associated with depressive symptoms better than physical function tests cross-sectionally. Changes of depressive symptom status were significantly associated with the lower-extremity function longitudinally. The emerging depression and chronic depression groups have poorer L/E physical function. When the depressive symptoms remitted, L/E physical function improved reversely.

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誌謝 ................................................. I
中文摘要.............................................. II
英文摘要.............................................. IV
第一章 緒論 .......................................... 1
1.1 研究背景與動機.................................... 1
1.2 研究目的 ........................................ 1
1.3 研究假說......................................... 5
1.4 研究重要性 ...................................... 5
1.5 名詞操作型定義.................................... 7
第二章 文獻回顧....................................... 10
2.1 老年憂鬱症與身體功能的概述......................... 10
2.1.1 憂鬱症....................................... 10
2.1.1.1 憂鬱症的定義...............................10
2.1.1.2 憂鬱症的重要影響............................12
2.1.1.3 老年憂鬱症盛行率與發生率.................... 14
2.1.1.4 老年憂鬱症的影響因子....................... 16
2.1.1.5 老年憂鬱症對健康成果的影響(health outcome).. 24
2.2 老年憂鬱症常用的篩檢量表 ............................27
2.2.1 美國流行病學研究中心憂鬱量表(Center for Epidemiologic Studies Depression Scale，CESD)........................27
2.2.2 老年憂鬱量表(Geriatric Depression Scale-30 items，GDS) ................................................. 28
2.2.3 簡易老年憂鬱量表(Geriatric Depression Scale - Short
Form 15，GDS-SF15).................................... 29
2.2.4 本研究施測量表的選用........................... 30
2.3 老年人的身體功能檢測............................... 30
2.3.1 老年人的身體功能 (Physical function)........... 30
2.3.1.1 身體功能的重要性........................... 31
2.3.2 老年人身體功能測試項目......................... 34
2.4 近年來老年憂鬱症與身體功能的相關研究................. 39
2.5 總結............................................. 45
第三章 研究方法........................................ 48
3.1 研究對象.......................................... 48
3.2 研究設計.......................................... 49
3.3 研究工具與測量方法................................. 49
3.3.1 基本資料表.................................... 49
3.3.2 測量工具...................................... 50
3.3.2.1 老人憂鬱傾向測量工具........................ 51
3.3.2.2 身體功能測量工具與測量方法.................. 51
3.3.2.3 簡易智能量表(Mini-mental state examination；
MMSE) ................................................ 53
3.4 實驗流程.......................................... 53
3.5 資料處理與統計分析................................. 54
第四章 結果........................................... 57
4.1 受測者之社會人口學與健康、疾病相關資訊................ 57
4.2 橫斷面之憂鬱傾向與基本資料及身體功能各變項的相關性..... 58
4.3 一年期追蹤之憂鬱傾向變化與身體功能表現分析............ 61
第五章 討論........................................... 64
5.1 受試者資料統整分析................................. 64
5.2 受試者資料統整分析................................. 70
5.2.1 心肺耐力...................................... 70
5.2.2 上肢肌力...................................... 71
5.2.3 下肢肌力...................................... 72
5.2.4 平衡表現...................................... 73
5.2.5 綜合功能性表現................................. 74
5.2.6 基本資料與身體功能表現對憂鬱傾向的綜合探討........ 75
5.3 一年後憂鬱傾向變化與其身體功能表現變化的探討.......... 77
5.4 研究限制.......................................... 82
第六章 結論........................................... 83
第七章 臨床應用........................................ 85
參考文獻............................................... 86
圖附錄................................................. 96
圖一、實驗流程圖.................................... 96
圖二、受試者接受測試之流程........................... 97
圖三、一年期不同憂鬱發展組別的計時起走表現............. 98
圖四、一年期不同憂鬱發展組別的六分鐘行走表現........... 99
圖五、一年期不同憂鬱發展組別的三十秒坐站表現........... 100
表附錄................................................ 101
表一、施測者間信度(受試者人數=6 施測者人數=3)......... 101
表二、受試者與流失老人的基本資料比較.................. 102
表三、受試者的基本資料.............................. 103
表四、受試者的功能表現(基準點)....................... 104
表五、憂鬱傾向與各變項的相關性....................... 105
表六、單一時間點憂鬱傾向預測因子之羅吉斯迴歸分析結果(未
調整)............................................. 106
表七、單一時間點憂鬱傾向預測因子之羅吉斯迴歸分析結果(調
整後)............................................. 106
表八、憂鬱傾向發展之人數表.......................... 107
表九、一年期憂鬱傾向發展與人口統計學變項的相關......... 108
表十、一年期計時起走與憂鬱傾向發展之共變數分析結果..... 109
表十一、一年期六分鐘行走與憂鬱傾向發展之共變數分析結果
................................................. 109
表十二、一年期手握力與憂鬱傾向發展之共變數分析結果..... 110
表十三、一年期三十秒坐站與憂鬱傾向發展之共變數分析結果.. 110
表十四、一年期閉眼單足立與憂鬱傾向發展之共變數分析結果.. 111
表十五、一年期功能性前伸與憂鬱傾向發展之共變數分析結果.. 111
附錄.................................................. 112
附錄一、簡易老人憂鬱量表(GDS-SF15).................. 112
附錄二、身體功能檢測項目............................ 114
附錄三、簡易智能量表................................ 121
附錄四、各年齡層其簡易智能量表(MMSE)的切割點.......... 124

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