台灣社區老年人居住安排與認知功能退化相關性探討

Cognitive Decline among The Community-dwelling Elderly with Different Living Arrangement in Taiwan

呂建駒(Chien-Chu Lu)

指導教授 ： 李孟智

中山醫學大學/醫學院/醫學研究所/碩士(2014年)

https://doi.org/10.6834/CSMU.2014.00157

摘要

前言：關於心智活動對於認知功能退化的影響，是一個很值得延伸探討的議題。不同的家庭結構及居住安排，對於人的生活及心智活動有相當程度的影響，而這也有可能成為左右認知功能退化的因素之一。故本研究將深入探討台灣社區中老年人居住安排，對於認知功能障礙及認知功能退化的相關性。
方法：本研究的資料來源自1999年及2007年的「台灣中老年人身心社會狀況長期追蹤調查」資料庫，從中篩選出符合條件的個案，包含：65歲以上不住在任何醫療機構中、且1999年至2007年期間內居住安排狀況未改變者。另外，依居住安排狀況分為1. 與配偶同居者、2. 獨居者以及3. 與配偶外其他人同居者共三組。此三組以交叉表的卡方檢定來描述收案者的基本資料。以ANOVA變異數分析來分析在三組不同的居住狀態下，SPMSQ(short portable mental status questionnaire)量表分數的差異及認知功能狀態的變化。最後，本研究將以邏輯斯迴歸分析來檢視各個不同的因素，與認知功能退化的相關性。
結果：本研究一共篩選出1029名個案，其中與配偶同居者有628名，獨居者有70名，而與配偶外其他人同居者為331名。在1999年及2007年的SPMSQ量表評估中發現：在居住安排分組的情況下，有認知功能障礙問題的比例，與配偶外其他人同居者最高(1999: 18.4%; 2007: 39.5%)，而與配偶同居者最少(1999: 5.7%; 2007: 19.6%)。另外在1999年到2007年間出現認知功能退化的比例，與配偶外其他人同居者同樣是最高(23.8%)，而與配偶同居者最少(12.4%)。透過邏輯斯迴歸分析發現，年齡越大(OR=1.084，95% CI=1.041 - 1.130)、女性(OR=1.904，95% CI=1.196 - 3.033)、婚姻狀況無配偶(OR=1.845，95% CI=1.008 - 3.377)及未與配偶同居者(OR=2.021，95% CI=1.118 - 3.655)，顯著增加認知功能退化的風險。
結論：本研究顯示，台灣社區中的老年人，與配偶同居者其認知功能障礙的比例較低及認知功能退化速度較慢，且未與配偶同居為認知功能退化的獨立危險因子。

關鍵字

社區老年人 ； 居住安排 ； 認知功能障礙 ； 認知功能退化

並列摘要

Objective:
Different family structures or living arrangements, may change the life style and mental activities of older people, and affect the rate of cognitive decline too. This study aims to explore the correlationship between different living arrangements and cognitive status among the community-dwelling elderly in Taiwan.
Methods:
We use the data set of “Long-term Survey of Health and Living Status of the Elderly in Taiwan”. From the wave of 1999 and 2007, we selected those who were age over 65 years, not living in institutions, and didn’t change their living conditions from 1999 to 2007 in the database. According to living arrangements, they were divided into three categories: 1. living with a spouse, with or without others, 2. living alone and 3. living with persons other than a spouse. We used SPMSQ (short portable mental status questionnaire) scale to evaluate the level of cognition and cognitive decline. Chi-Square test was to describe the basic information of selecting people; ANOVA (Analysis of variance) test was used to analyze the difference in SPMSQ scale score, including cognitive impairment and cognitive decline from 1999 to 2007 in the three different categories. Finally, Logistic regression analysis was performed to see the correlationship among the various factors and cognitive decline.
Results:
The study selected 1,029 persons divided into three categories from the database: 1. living with a spouse: 628 persons, 2. living alone: 70 persons, and 3. living with persons other than a spouse: 331 persons. In the SPMSQ scale assessment, those living with a spouse had the least rate of cognitive impairment (1999: 5.7%; 2007: 19.6%); those living with persons other than a spouse had the highest rate of cognitive impairment (1999: 18.4%; 2007: 39.5%). Those living with a spouse also had the least rate of cognitive decline among the three group (12.4%), and those living with persons other than a spouse had the highest rate of cognitive decline(23.8%). Logistic regression analysis revealed that the older age (OR=1.084, 95% CI=1.041 - 1.130), women (OR=1.904, 95% CI=1.196 - 3.033), no spouse (OR=1.845, 95% CI=1.008 - 3.377), and not living with a spouse (OR=2.021, 95% CI=1.118 - 3.655), had higher risk for cognitive decline.
Conclusions:
According to the study results, those living with a spouse had the lower rate of cognitive impairment and cognitive decline, and not living with a spouse was an independent risk factor for cognitive decline among the community-dwelling elderly in Taiwan.

並列關鍵字

community-dwelling elderly ； living arrangement ； cognitive impairment ； cognitive decline

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