臺灣中老年人中風後身體功能變化歷程之性別差異探討

Differences Between Men and Women in Physical Function Change After Stroke

吳昌政(Chang-Chen Wu) ； 邱靜如(Ching-Ju Chiu) ； 黃湘閔(Hsiang-Min Huang) ； 呂宗學(Tsung-Hsueh Lu)

《健康科技期刊》 2018專刊 (2018/12) Pp. 80-92

https://doi.org/10.6979/TJHS.201812/SP.0008

摘要

目的：了解臺灣中老年中風患者長期日常生活功能的下降速度及軌跡是否有性別差異及其相關因子探討。方法：利用領航國際之活躍老化監測暨決策支援系統研究計畫所建構的「中高齡健康與失能歷程資料庫」之1996至2007年間自評曾罹患過中風之50歲以上患者探討其在日常生活功能指標(ADL)及工具性日常生活活動指標(IADL)的變化趨勢及性別差異。藉由階層線性模型(Hierarchical linear model, HLM)分析並矯正追蹤過程中可能對身體功能產生影響之干擾因子，如：社會人口學及健康疾病相關因子等，提出中風失能歷程之實證分析。結果：追蹤期間之中老年中風患者共700位，平均年齡為73.46±8.43歲，女性佔297位(42.43%)。研究結果顯示中風患者罹病後的日常生活功能變化與性別無直接關聯，主要是透過其他健康或社會問題，如：糖尿病、髖骨骨折、視力障礙、憂鬱、記憶功能受損、非婚姻或無伴和社會支持下降等變化，導致日常生活功能下降。而工具性日常生活功能則顯示即使已控制共病的問題，女性的下降速度仍較快，但在加入婚姻或有伴狀況變項後，此差異性即消失。結論：中老年中風患者ADL及IADL變化軌跡之性別差異受到共病症及婚姻或無伴狀況的影響，故若中風患者能避免罹患相關共病和確保適切之陪伴，則中風後失能之狀況可以大幅降低。

關鍵字

中風 ； 身體功能 ； 性別差異 ； 中老年人 ； 長期追蹤資料

並列摘要

Purposes: To investigate factors associated with the decline of long-term activities of daily living in patients with stroke in Taiwan, and to examine if there exist gender differences. Methods: Data on patients aged over 50 years who self-reported incidence of stroke during the period from 1996 to 2007 in the ＂Disability Process Database,＂ which constructed by Project of Active Ageing Database Integration, Value-Added Analysis and Project Management, were analyzed. Hierarchical linear model (HLM) was used to analyze the stroke disability trajectories while adjusting the confounding factors that might affect physical function in the longitudinal process, such as social demographics and health-related disease factors. Results: A total of 700 middle-aged and elderly stroke patients were enrolled, with an average age of 73.46 ± 8.43 years. Patients composes 297 women (42.43%). The results of the study show that the ADL changes after stroke in patients are not directly related to gender, mainly through other health or social problems such as: diabetes, hip fracture, visual impairment, depression, memory impairment, unmarried or no partner, and decline in social support. The IADL shows that even if comorbidity has been controlled, the rate of decline of women is still relatively fast, but this difference disappears after added the marriage or partner status. Conclusions: Gender differences in the trajectory of ADL and IADL in middle-aged and elderly patients with stroke are affected by comorbidities and marital status or partner status. This study concluded that if patients with stroke can prevent comorbidity development, and can be accompanied by their family or friends with satisfied support, the disability after stroke may be greatly mitigated.

並列關鍵字

Stroke ； Physical function ； Gender difference ； Middle-aged and older adults ； Trajectory

參考文獻

Bennett, K. M.,Stenhoff, A.,Pattinson, J.,Woods, F.(2010)."Well if he could see me now": the facilitators and barriers to the promotion of instrumental independence following spousal bereavement.J Gerontol Soc Work.53(3),215-234.

Berard, D. M.,Vandenkerkhof, E. G.,Harrison, M.,Tranmer, J. E.(2012).Gender differences in the influence of social support on one-year changes in functional status in older patients with heart failure.Cardiology Research and Practice.2012,616372.

Centers for Disease Control and Prevention, C.(2007).Outpatient rehabilitation among stroke survivors--21 States and the District of Columbia, 2005.MMWR: Morbidity and Mortality Weekly Report.56(20),504-507.

Chiu, C. J.,Hu, S. C.,Wray, L. A.,Wu, S. T.(2016).The Short- and Long-Term Effects of Psychobehavioral Correlates in Buffering Diabetes-Related Cognitive Decline.Ann Behav Med.50(3),436-444.

Fitzgerald, J. T.,Davis, W. K.,Connell, C. M.,Hess, G. E.,Funnell, M. M.,Hiss, R. G.(1996).Development and validation of the Diabetes Care Profile.Evaluation and the Health Professions.19(2),208-230.