台灣2009年65歲以上老人跌墜傷患住院醫療利用及影響因子之探討

Health Service Utilization and Related Factors of Taiwanese Elderly Fall Inpatients in 2009

鄭以晨(I-Chen Cheng) ； 曾雅梅(Ya-Mei Tseng) ； 簡戊鑑(Wu-Chien Chien)

《臺灣老人保健學刊》 7卷1期 (2011/06) Pp. 55-71

https://doi.org/10.29797/TJGHR.201106.0003

摘要

內政部統計資料顯示，至2009年底，我國65歲以上老年人總計2,457,648人（佔全人口數10.63%），且有逐年增加之趨勢，預估在2021年，老年人口比例將達到總人口數14%，而進入高齡社會(aged-society)。本研究使用2009年「全民健保資料庫」住院檔，選取65歲以上跌倒墜落傷患（E-code碼介於880-888），並以統計軟體SPSS18.0版進行分析。研究結果顯示，2009年老人跌倒墜落住院總人數共有33,370人，其中，墜落傷害為主因(56%)，另外，老人跌墜傷患以女性居多（62.83%，20,968人），傷者年齡以75-84歲比例最高(46.46%)，全體老人跌墜住院傷患中，低收入戶及重大傷病患者的比例分別為1.63%及7.43%，約六成老人跌墜住院傷患發生骨折傷害且至骨科就診，同時在全部老人跌墜住院傷患中，高達81.96%有接受手術處置，另外，老人跌墜傷患至區域醫院就醫的比例最高(55.21%)。老人跌墜傷患住院醫療利用（包含住院費用及天數）影響因子為年齡、重大傷病、傷害類型、就醫科別、手術處置、醫院層級及住院預後情形等。相關單位應更重視老人跌墜入院的問題，除了降低老人跌倒墜落的發生外，應針對醫療利用影響因子進行適當防治計畫，亦必須加強傷害外因編碼之完整性，以更準確的瞭解跌墜傷害情形，以減少老人跌墜住院的醫療利用。

關鍵字

老人 ； 跌倒墜落 ； 住院 ； 健保資料庫

並列摘要

The ministry of the interior shows that there were 2,457,648 elderly people in 2009 and the population aged 65 and older will approach 14% in 2021 (aged-society). This research brought 'inpatient expenditures by admissions (DD)' and 'registry for contracted medical facilities (HOSB)' from national health insurance research database in 2009. We selected, based on International classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) code, injury cases of elderly fall injuries. Statistical analysis was performed with the logistic regression, and analyzed with SPSS 18.0, all statistical tests were conducted at 5% level of significance. There were 33,370 inpatient cases caused by elderly fall injuries (males 37.17%, females 62.83%), and the main reason was fall from different level (56%). Inpatients were major in 75-84 age groups (46.46%). Of all elderly fall inpatients, we found that the percentage of low income and catastrophic illness were 1.63% and 7.43%. Most inpatients received surgeries, operations or treatments (81.96%) and were sent to regional hospitals, which had higher percentage than all other hospitals (55.21%). The factors associated with health service utilization caused by elderly fall injuries were ages, catastrophic illness, type of injuries, department, operations and treatments, hospital level and prognosis by multivariate logistic regression analysis. We suggest that government agencies should focus on elderly fall inpatients and develop prevention strategies for intervention programs to reduce fall injuries and the consumption of medical resources.

並列關鍵字

Elderly ； falls ； hospitalization ； national health insurance database