Factors Associated with One-Year Mortality of Patients Receiving Home Healthcare Service in a Regional Hospital in Northern Taiwan

北部某醫院居家照護個案一年存活之相關因素探討

黎家銘(Chia-Ming Li) ； 李中一(Chung-Yi Li) ； 陳佩琦(Pei-Chi Chen) ； 張皓翔(Hao-Hsiang Chang)

《台灣家庭醫學雜誌》 30卷2期 (2020/06) Pp. 68-77

https://doi.org/10.3966/168232812020063002002

摘要

Background: Disabled people are increasing as a result of the fast growing elderly population in Taiwan, leading to an increase in need for home healthcare. The medical decision made without considering the prognosis might give more harm than benefit to those weaker disabled homecare patients. We aimed to explore the factors associated with one-year mortality in our home healthcare cases to get a better knowledge of those with poor prognosis. Methods: Cases receiving home care from 1990 to 2008 at National Taiwan University Hospital, Bei-Hu Branch were enrolled. We used the life table method to estimate the cumulative survival rate and logistic regression model to explore the independent risk factor for mortality within 1 year after enrollment. Results: There were 723 cases receiving our home healthcare from 1990 to 2008. The characteristics of the study cases were predominated by males (51.8%) and those aged 75-84 years (33.9%). The 1 to 5-year cumulative mortality rates were 25.0%, 38.5%, 48.8%, 57.4 and 65.9% respectively. Cases in the 75-84 age group (adjusted odds ratio (AOR) 1.49, 95% CI 1.11-2.00), over 85 years old (AOR 1.79, 95% CI 1.32-2.43), with higher Charlson Comorbidity Index (CCI) score two (AOR 1.92, 95% CI 1.26-2.92); three (AOR 2.11, 95% CI 1.34-3.32); and equal or above 4 (AOR 3.35, 95% CI 2.11-5.32) were all independently associated with 1-year mortality. Conclusions: Age and disease severity were significantly associated with 1-year mortality for the patients receiving home healthcare service of the study area in Taiwan.

關鍵字

age ； comorbidity ； home health care ； mortality

並列摘要

目的：隨著高齡化伴隨的失能者增加，台灣民眾對居家照護的需求也與日俱增，居家照護工作中，本著病患預後的評估來進行醫療決策是必要的，否則可能帶來的是災難而非救治，本研究以分析居家照護個案的一年存活相關因子，希望能提供更多的資料探討居家照護者的預後，提供居家照護醫療決策的實證基礎。方法：本研究納入北部某地區醫院1990至2008年接受居家護理照護個案，以病歷回顧方式進行，以生命表呈現存活資料，以羅吉斯回歸探討個案納入後一年內存活的相關因素探討。結果：研究共納入723位個案，男性占51.8%，年齡介於75-84歲者占33.9%最多，1-5年死亡率分別為25.0%、38.5%、48.8%、57.4及65.9%。以邏輯斯迴歸分析一年內死亡的相關因子，顯示獨立相關因子包括年齡介於75-84歲（校正後風險比1.49；95%信賴區間1.11-2.00）、85歲以上（校正後風險比1.79；95%信賴區間1.32-2.43），查爾森共病指數（Charlson Comorbidity Index）為2者（校正後風險比1.92；95%信賴區間1.26-2.92）、為3者（校正後風險比2.11；95%信賴區間1.34-3.32）、4或以上者（校正後風險比3.35；95%信賴區間2.11-5.32）。結論：年齡與疾病狀態是影響居家照護個案一年內死亡的危險因子，居家健康照護工作者面對個案評估與醫療決策時，應將此二因素列入預後評估中。

並列關鍵字

居家照護 ； 死亡率 ； 共病 ； 高齡

參考文獻

Yang Y, Brown CJ, Burgio KL, et al: Undernutrition at baseline and health services utilization and mortality over a 1-year period in older adults receiving Medicare home health services. J Am Med Dir Assoc 2011; 12: 287-94.

Umegaki H, Asai A, Kanda S, et al: Factors associated with unexpected admissions and mortality among low-functioning older patients receiving home medical care. Geriatr Gerontol Int 2017; 17: 1623-7.

Inouye SK, Peduzzi PN, Robison JT, Hughes JS, Horwitz RI, Concato J: Importance of functional measures in predicting mortality among older hospitalized patients. JAMA 1998; 279: 1187-93.

John G, Gerstel E, Jung M, et al: Urinary incontinence as a marker of higher mortality in patients receiving home care services. BJU Int 2014; 113: 113-9.

Onder G, Liperoti R, Soldato M, Cipriani MC, Bernabei R, Landi F: Chewing problems and mortality in older adults in home care: results from the Aged in Home Care study. J Am Geriatr Soc 2007; 55: 1961-6.