台灣中老年健康行為與可避免住院之相關因素探討

Factor Associated with the Health Behavior and Avoidable Hospitalization in Taiwan’s Middle-age and Elder

陳俊宇(Chun-Yu Chen)

指導教授 ： 紀玫如

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2010年)

https://doi.org/10.6833/CJCU.2010.00050

摘要

目的：本研究目的主要為了解台灣地區中老年可避免住院之整體現況，並探討個人健康行為對可避免住院之影響。
方法：本研究採橫斷式研究，資料來源為行政院衛生署國民健康局「民國九十二年台灣地區中老年身心社會生活狀況長期追蹤第五次調查」資料庫中，50歲以上之受訪個案。研究對象篩選條件為需由本人回答，且樣本在經醫師診斷後，確認有罹患高血壓、糖尿病、心臟病、肺部疾病、胃部疾病、及腎臟疾病中任一項疾病；進而篩選有參加全民健康保險者，共計有2,302人為研究樣本。可避免住院(Avoidable Hospitalization)為2009年美國健康照護研究及品質局(AHRQ)提供13種門診照護敏感狀況(ACSCs)ICD9-CM疾病編碼列表所定義；健康行為則以樣本是否有執行健康促進行為（包括運動程度、定期量血壓、量血糖、抽血檢查、血液檢查情形、定期健康檢查、預防行為、及病病管理等，共8種）與健康危害行為（包括抽菸情形、喝酒情形、及嚼檳榔情形等，共3種）作為測量變項。
結果：中老年人發生可避免住院之盛行率為7.8%；再區分50-64歲之中高齡者與65歲以上之高齡者之可避免住院盛行率則發現，中高齡者盛行率較高為8.6%，高齡者則為7.5%。邏輯斯迴歸分析結果發現，與可避免住院之相關因子為無身體功能困難(OR=1.48，95% C.I.=1.01-2.17)、一年內有利用急診情形(OR=1.56，95% C.I.=1.05-2.32)、及無預防保健行為(OR=2.05，95% C.I.=1.17-3.60)。若將中高齡者與高齡者分別進行分析，結果發現高齡者居住在都市化程度較高地區者，包括省轄市(OR=2.22，95% C.I.=1.26-3.92)、無身體功能困難(OR=1.66，95% C.I.=1.07-2.60)、無抽菸者(OR=2.21，95% C.I.=1.07-4.56)、無主動執行預防保健行為(OR=2.09，95% C.I.=1.05-4.16)以及有定期健康檢查者(OR=2.02，95% C.I.=1.01-4.05)，出現可避免住院的機會均顯著較高。
結論：本研究結果發現健康行為與可避免住院間有顯著的相關性。面對越來越多的老年人口及有限的醫療資源，建議衛生相關單位應針對中老年人族群推廣健康促進行為，並宣導健康危害行為對健康之影響；並透過慢性病自我照顧之相關資訊，提高中老年人自我維護健康的意識，鼓勵持續就醫治療慢性病，減緩惡化或併發症的發生，進而降低醫療資源的耗用。

關鍵字

中老年 ； 健康行為 ； 可避免住院

並列摘要

Purpose: To examine the avoidable hospitalization prevalence among older adults and the relationship between health behaviors and avoidable hospitalization.
Methods: This study was a cross-sectional study and the data was from "Survey of the Health and Living Status of the Middle-Aged and the Elderly in Taiwan" in 2003. Older adults who had at least one ambulatory care sensitive conditions were recruited. Agency of Healthcare Research and Quality (AHRQ) proposed 13 types of ambulatory care sensitive conditions (ACSCs) as avoidable hospitalization, and the list included Hypertension, diabetes, heart disease, lung disease, stomach disease, and renal disease in our analysis. Health behaviors included health-promoting behaviors (such as exercise, pressure and blood check, blood tests, disease prevention and management) and the health risk behavior (such as smoking, drinking and chewing betel nut).
Result: The prevalence of avoidable hospitalization rate was 7.8% in our sample. Elders had higher prevalence rate then the middle-aged (8.6% and 7.5%) Logistic regression showed that, after controlling for other variables, subjects had no difficulty of daily activity (OR=1.48, 95% C.I.=1.01-2.17), emergency visit (OR=1.56，95% C.I.=1.05-2.32) and not implemented preventive care actively(OR=2.05, 95% C.I.=1.17-3.60) tend to have avoidable hospitalizations. And we also found out that subjects who lived in higher urbanization area (OR=2.22, 95%CI=1.26-3.92), had no difficulty of daily activity (OR=1.66, 95% C.I.=1.07-2.60), were non-smoking (OR=2.21, 95% C.I.= 1.07-4.56), not implemented preventive care actively(OR=2.09, 95% C.I.= 1.05-4.16) and had regular health examination behaviors among elders (OR=2.02, 95% C.I.= 1.01-4.05) had higher chance to have avoidable hospitalization.
Conclusions: This study found out that there were relationship between health behaviors and avoidable hospitalization significantly. As increasing number of elderly population and limited health care resources, we recommend that health department should encourage the elderly population to implement health-promoting behaviors and quit health risk behaviors. On the other hand, we should empower self-awareness and self-management of chronic diseases to prevent the deterioration of diseases and contain the increasing use of medical resources among elderly.

並列關鍵字

middle age and elder ； health behavior ； avoidable hospitalization

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