臺灣中老年人跌倒之危險因子與其醫療使用分析

Risk Factor of Fallings and the Associated Medical Utilization among Elderly in Taiwan

黃鈺心(Yu-Hsin Huang)

指導教授 ： 張宏浩

國立臺灣大學/生物資源暨農學院/農業經濟學研究所/碩士(2012年)

https://doi.org/10.6342/NTU.2012.02759

摘要

隨著醫療技術的進步，平均餘命延長，老年人口逐年增加且有急遽上升之趨勢，人口老化已成為全球關注的重要議題，我國亦是如此。根據統計資料顯示，「跌倒」為老年人最常見的死因及住院原因，跌倒的影響不僅於生心理健康，亦擴及各項醫療資源的使用程度及社會成本。然而，台灣之研究大多僅著重於老人跌倒危險因子之分析，關於老人跌倒與醫療資源耗用關係之探討仍相當缺乏，且對此議題的探討大多出現於公共衛生領域，較少有完整量化且全國代表性樣本之分析。因此本研究目的有二，其一為檢驗常見的老人跌倒危險因子；其二為估計跌倒對於各項醫療使用與醫療費用的影響。

本研究利用「台灣地區中老年身心社會生活狀況長期追蹤調查」1999與2003年的追蹤資料，針對臺灣50歲以上之中老年有效樣本共2,108人，針對資料不同的特性，分別以Probit Model、負二項模型與Tobit Model分析。實證結果發現顯著的老人跌倒危險因子中，年齡、女性、抑鬱指數與過去慢性疾病數目皆會提高跌倒發生機率；運動、日常生活活動能力的提升則有降低跌倒機率的效果。醫療使用方面，跌倒的發生對於各項醫療使用皆有負面影響，意即老年人的跌倒事件會顯著增加所有醫療資源的耗用；但跌倒次數與醫療資源使用的關係則隨著不同性別與不同的醫療部門而有所差異。若比較跌倒之影響程度，在住院相關醫療使用上，男性跌倒之影響大於女性；其他醫療費用及急診次數，男性跌倒之影響效果則明顯低於女性。

由本研究結果可發現老人跌倒對於各項醫療使用皆有負面影響效果，跌倒確實為增加醫療資源與社會成本的一大成因。因此政府應加強醫療配套措施及衛生教育，宣導病患或家屬對跌倒意外的了解，加強預防跌倒之教育。此外，更應考量性別產生之差異，藉由生心理健康之照顧、居住環境安全之維護，期能減少老人跌倒意外，降低跌倒造成的龐大醫療社會成本、減少國家之經濟負擔。

關鍵字

老年人 ； 跌倒 ； 危險因子 ； 醫療使用 ； Probit Model ； 負二項模型 ； Tobit Model

並列摘要

Due to the progress of medical technology, the average life expectancy extends and the elderly population is increasing rapidly. To date, aged population has become an important issue around the world. According to the statistics, "falling" is the most common cause of death and hospitalization among elderly people. The impact of falling is not only on physical and mental health, but also on the medical utilization. However, most of the existing studies only focus on risk factors of fallings. Nowadays, the analysis of relationship between falls and medical utilization still lacks in Taiwan, and the subject mostly appears in the field of public health, less complete and quantified analysis of a nationally representative sample. To remedy the gap of the existing studies, one purpose of this paper is to test common risk factors of falls among elderly, another is to estimate the effects of falling on the medical utilization and medical costs in Taiwan.

In total, 2,108 older people drawn from Taiwan Longitudinal Study on Aging in 1999 and 2003 were selected for empirical analysis. The Probit model, Negative Binomial model and Tobit model were estimated for the risk factors and associated medical costs that are assoicated with fallings, respectively. Results show that age, female, depression score, and number of chronic disease would increase the probability of falling; the enhance of exercise, activities of daily living will reduce fall probability. The results also reveal that falling has a significant positive impact on all types of medical utilization in total and female sample; older man’s falls are more significantly associated with inpatient-related medical utilization. Comparing the impact of falls between men and women, the effect on inpatient utilization for males is larger than females; the effect of male falls on other medical expenditures and emergency department visits is obviously lower than the female’s.

According to these results, we can conclude that fallings among the elderly have increased various medical utilization, and fallings are indeed a major cause of increase in medical costs. Therefore, in order to reduce the medical expenditure and the economic burden of the country, the government should strengthen medical support measures and promote health education in prevention of falling.

並列關鍵字

elderly ； falls ； risk factor ； medical utilization ； Probit Model ； Negative Binomial Model ； Tobit Model

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