Health Decline in the Elderly: Course and Interrelationships with Major Associated Factors

社區老人的健康狀況變化及其相關因素研究

陳君敏(Chun-Min Chen) ； 李易蓁(I-Chen Lee) ； 謝佩珊(Pei-Shan Shih) ； 邱亨嘉(Herng-Chia Chiu)

《The Changhua Journal of Medicine》 15卷4期 (2017/12) Pp. 165-175

https://doi.org/10.6501/CJM.1504.001

摘要

Background: This study evaluated changes in physical functioning in an elderly population in Taiwan and the associations between health changes and various factors. Methods: Data were collected from the Longitudinal Study of Aging database. Data for 1,581 samples were derived from a two-wave cohort study in Kaohsiung, Taiwan. Functional status was assessed via the physical activities of daily living (PADL) and instrumental activities of daily living (IADL) scales. Health decline was classified as disability, institutionalization, and death. A multinomial logistic regression model was used to predict factors responsible for health decline across different waves of data. Results: Throughout the study period, the proportion of the elderly population with normal functioning decreased with time. Factors associated with functional decline were unsatisfactory social support, diabetes, stroke, and poor self-reported health. In addition, poor self-reported health and unsatisfactory social support were strongly related to institutionalization. Poor self-reported health, diabetes, and depression were also significant predictors of death. Increasing trends with time were observed for IADL and PADL disabilities, especially regarding housework and using the toilet, supporting the notion of health decline with age. Conclusion: Increased awareness of cohort characteristics and improving social support, self-reported health, and mental health are crucial in the aging population, and preventive care should be prioritized.

關鍵字

cohort study ； disability ； institutionalization ； death ； elderly

並列摘要

目的：本研究探討社區老年人健康變化情形，瞭解導致身體功能衰退、入住機構及死亡之相關影響因子。方法：本研究樣本為完成兩波調查之高雄市社區老人，共計1,581人納入分析。功能狀態評估包含日常生活(physical activities of daily living, PADL)和工具性日常生活(instrumental activities of daily living, IADL)活動功能變化。健康惡化情形包含失能，入住機構和死亡。本研究採用多元迴歸分析，探討影響健康衰退（ADL、入住機構及死亡）之相關因子，研究工具為利用老人健康流行病學問卷調查資料庫。結果：老年身體功能及健康狀況隨年齡而衰退。缺乏社會支持會增加日後入住長照機構之機會及身體功能衰退之風險；自覺身體健康狀況不佳會增加入住長照機構及死亡的風險；罹患糖尿病、中風、憂鬱症則會增加ADL衰退及死亡之風險。IADL和PADL失能顯著增加，特別是在做家務和如廁功能方面。討論：改善社會支持，自覺健康和身心狀態對人口老齡化至關重要，因此給予完善之社會支持和家庭資源可提供預防性保護，對於老年身心健康均有所提升。

並列關鍵字

世代研究 ； 失能 ； 機構 ； 死亡 ； 老人