都市與鄉村社區老年人的健康狀態及老年病症候群之比較

Comparison of Health Status and Geriatric Syndromes in the Elderly between Urban and Rural Communities

錢鴻全(Hung-Chuan Chien) ； 楊登棋(Deng-Chi Yang) ； 黃基彰(Chi-Chang Huang) ； 吳美慧(Mei-Hui Wu) ； 蘇怡華(Yi-Hwa Su) ； 蔡明松(Ming-Song Tsai) ； 邱智鈴(Ge-Lin Chiu) ； 張美珍(Mei-Jen Chang) ； 張嘉蘋(Jia-Ping Chang) ； 張家銘(Chia-Ming Chang)

《台灣老年醫學暨老年學雜誌》 7卷4期 (2012/11) Pp. 233-245

https://doi.org/10.29461/TGG.201211.0003

摘要

目的：不同地區的居民其健康狀況會有不同的差異，在規劃醫療照顧上需要不同的考量。目前健保免費提供每年一次的健康檢查，但對於與老年人的健康息息相關之老年病症候群篩檢卻未列入。因此本研究主要比較城鄉地區老年人的老年病症候群及老年人身體活動功能的差異。方法：本研究選擇大台南市北區的長榮社區與鄉村地區的玉井區及南化區年齡大於65歲的老年人作為收案對象，研究資料的收集包括問卷調查、基本生理數據測量及身體功能評估，並依城鄉地區分為二組進行統計比較分析。結果：都市社區的老年人平均年齡跟受過教育的比率較高，高血壓及糖尿病的盛行率也較高。吸菸率、喝酒習慣與嚼檳榔率，在城鄉比較無明顯統計上差異。在都市地區老年人平均身高與平均體重明顯高於鄉村地區，但身體質量指數無明顯差異。老年病症候群方面，這兩個地區老年人的跌倒史、尿失禁與憂鬱篩檢陽性比例無明顯統計上差異。在身體活動功能方面，都市社區有跌倒史的老年人在三公尺計時起走的平均測試秒數較鄉村地區為長，且達到統計上的意義；都市社區有跌倒史的老年人在三公尺計時起走測試大於20秒的人數比例也較鄉村地區為高，但是沒有達到統計上的意義。都市社區老年人握力的平均數值跟握力正常的人數比例都明顯低於鄉村地區，但連續坐站五次時間平均值卻是都市社區優於鄉村地區的老年人，且都達到統計上的差異。認知功能及日常生活活動功能表現在這兩個地區均無統計上之差別。結論：本研究中有相當比率的老年人有跌倒史、尿失禁與疑似憂鬱及心智功能障礙，以及出現任一種日常生活功能障礙，這個族群可能是目前全民健保健康檢查篩檢不到、但卻需要積極介入處置的高危險老年人族群。鄉村及都市的老年人在老年病症候群及日常生活功能表現雖然沒有明顯差異，可是在不同身體功能測試數據卻有明顯的地區矛盾差異，值得進一步探討。在預防跌倒及改善老年人日常生活功能上，以及對於衰弱與骨骼肌減少症的定義上，必須考慮到都市與鄉村社區的特性差異，方能提供老年人更完善的健康評估與照顧。

關鍵字

鄉村 ； 都市 ； 老年人 ； 健康檢查

並列摘要

Objectives: As health status of residents varies by area, medical care needs to be planned in a manner that meets the diverse health needs of residents living in different areas. Though the National Health Insurance (NHI) provides the elderly with one free health check-up every year; screening for geriatric syndromes is not included. The aim of this study was to investigate and compare the geriatric syndromes and physical activities between the urban-dwelling elderly and their rural counterparts. Methods: The study focuses on elderly (aged ≥ 65 years) citizens of Tainan City residing respectively in the urban Chang-Rong Community in the North District and in the rural Yu-Jiing and Nan-Hua Districts. Information were collected via questionnaire survey, basic physical examinations, and measurements of physical performance. Data were analyzed by comparing the two groups-urban and rural-of elderly citizens. Results: The urban-dwelling elderly reported a higher degree of education, a higher mean age, and a higher prevalence of hypertension and diabetes mellitus while no significant difference was detected between the two groups in terms of smoking, drinking, and betel nut chewing. The mean body height and weight of urban dwellers were significantly higher, but there was no statistical difference in the body mass index. Similarly, in terms of geriatric syndromes, the two groups showed no statistical difference in the percentages of falling, urine incontinence, and suspected depressive disorders. As for physical performance measurements, the mean time of completing the Get up-and-Go Test was statistically longer in the urban elderly with falling history, who were further marked with a higher, but not statistically so, percentage of Get up-and-Go Test ≥ 20 seconds. The average hand grip strength and the percentage of the elderly with normal grip strength in urban area are statistically lower than those in rural area. The urban individuals presented a statistically better performance in the Five-Chair-Standing test than the rural ones. There was no statistical difference in cognitive function and activities of daily living (ADLs) between both communities. Conclusion: Our study shows that the elderly in both urban and rural communities are at a considerably high risk of falling, urine incontinence, suspected depressive disorders, cognitive impairment, and impairment of ADL, all of which requires active intervention but cannot be screened in the current NHI annual health examination. There was no significant difference in geriatric syndrome and ADLs between the urban and rural elderly, but measurements of physical performance did report significantly reciprocal discrepancy. These differences caused by urban and rural environments should thus be duly considered in preventing falling and improving ADLs in the elderly so as to provide them with more effective and comprehensive health care.

並列關鍵字

Rural community ； urban community ； the elderly ； health check-up