為瞭解我國老人安眠藥的使用情形,本研究利用「全國長期照護需要評估」第一階段隨機抽取的樣本,從中挑選出失能老人,再連結到全民健保門診申報檔獲得其就醫與用藥資訊,研究期間從2001年7月至2002年6月,分析全國失能老人使用安眠藥之情形,包括使用率、使用種類、使用天數、連續使用、重複用藥與不適當用藥等,以及影響安眠藥使用情形的因素。 在一年的研究期間內,共有30.1%的老人服用過安眠藥,最常使用的安眠藥品項為lorazepam、zolpidem、estazolam、zopiclone、diazepam;有30.9%的安眠藥使用者在一年內的使用天數超過180天,有超過五成的使用者連續服用安眠藥超過28天,有17.1%的使用者在同一天使用兩種以上安眠藥,並且約有15.5%的使用者使用了不建議老人服用的安眠藥。 以邏吉斯複迴歸分析安眠藥使用情形之影響因素,分析結果顯示:女性、年齡在65-74歲者、外省人、有配偶、居家聘有全職看護(OR=1.709)、只有IADL障礙者(OR=1.456)、罹患3種以上慢性病者、以及罹患心臟病、精神疾病(OR=2.219)、巴金森氏症、癌症者,服用安眠藥的可能性較高。。籍貫為外省人、居住在直轄市、國中以上教育程度、居家聘有全職看護(OR=1.502)、及罹患心臟病、中風、精神疾病(OR=1.914)、巴金森氏症與嚴重身體功能障礙者(OR=1.478),連續使用安眠藥超過28天的可能性較高。居家聘有全職看護(OR=1.388)、患有精神疾病(OR=2.611)、及嚴重身體功能障礙者(OR=1.485),重複用藥之可能性較高。患有心臟病、中風、糖尿病、失智症者,使用不適當用藥的機率較低;而罹患三種慢性病以上者(OR=1.949),有不適當用藥的機率較高。
To understand the hypnotic drug use among disabled elderly in Taiwan, the objects and information was obtained from the “Evaluation of Taiwan National Requirements for Long-Term Care”. This data was linked to the National Health Insurance claim database to obtain all prescription data from western medical ambulatory visits between July 2001 and June 2002. The prevalence rate of hypnotic drug use among disabled Taiwanese elders were 30.1%. The most popular hypnotic drug was lorazepam, followed by zolpidem, estazolam, zopiclone, diazepam. 30.9% of hypnotic users use hypnotics more than 180 days during the study year, and more than half users use hypnotics more than 28 days continuously. 17.1% of hypnotic users used more than one kind hypnotics in the same day, and about 15.5% of users used potentially inappropriate hypnotics. In multivariate logistic regression models, female, age between 65-74 years old, married, dwelling in community with a fulltime caregiver(OR=1.716), and with heart disease, stroke, psychiatric diseases(OR=2.231), parkison’s disease and cancer, only IADL disabled(OR=1.452) and more than 3 kinds of chronic diseases were more likely to use hypnotics. Significant correlates of continuous use more than 28 days were mainlanders, living in big cities, higher education, dwelling in community with a fulltime caregiver(OR=1.505), and with heart disease, stroke, psychiatric diseases(OR=1.926), having serious disabled(OR=1.479). Significant correlates of multiple hypnotic use dwelling in community with a fulltime caregiver(OR=1.377), psychiatric diseases(OR=2.628), seriously disabled. Patients who were seriously disabled were more likely to have potentially inappropriate hypnotic use(OR=1.930).