臺灣長者居住安排對醫療服務利用影響之研究

A Study on the Impact of Elderly Living Arrangements on Medical Service Utilization

謝佳敏(Chia-Min Hsieh)

指導教授 ： 李淑杏

中山醫學大學/醫學院/護理系長期照護碩職專班/碩士(2022年)

https://doi.org/10.6834/csmu202200197

摘要

背景動機：在臺灣國人平均餘命延長、生育率下降及家戶規模的縮小影響下，長者居住安排為「僅與配偶同住」以及「獨居」之比例仍持續上升。目前多數居住安排對於醫療服務利用的研究僅著重於是否獨居或與子女同住，國內鮮少研究探究其他種類的居住安排。
研究目的：探討臺灣長者不同居住安排對醫療服務利用之影響。
研究方法：本研究為橫斷性次級資料分析法，使用衛生福利部民國100年臺灣中老年身心社會生活狀況長期追蹤調查(Taiwan Longitudinal Study on Aging, TLSA)資料，以2,426名65歲以上之長者為研究對象，以傾向因素、能用因素、需要因素三大構面及對應指標作為研究架構。以敘述性統計、卡方檢定，探討人口學特性、健康狀況、居住安排及醫療服務利用情形(住院、急診及西醫門診)，並進行控制人口學特性、健康狀況，透過羅吉斯迴歸來分析長者居住安排對於醫療服務利用之影響。
研究結果：研究對象平均年齡為76.8歲，女性及男性比例相近。居住安排有5.6%僅與親戚或其他非親戚同住、10.3%獨居、18.1%僅與配偶同住、66%與家人同住。長者過去1年內有23.1%住過院、25.0%使用過急診及94.3%看過西醫門診。居住安排部分為「僅與親戚或其他親戚同住」較其他居住安排有較高的住院和急診利用比例，且發現影響醫療服務利用的主要因素為自評健康、疾病狀況、日常生活活動及心理健康狀況最顯著。在同時考量人口學特性、健康狀況等相關因素下，研究結果為臺灣長者之居住安排對住院、急診或西醫門診等醫療服務利用，在統計上皆無顯著影響。然而若僅觀察居住安排與醫療服務利用的關係，顯示「僅與親戚或其他親戚同住」的長者在住院及急診醫療服務利用比其他居住安排高。
研究結論：影響臺灣長者住院、急診與西醫門診之醫療服務利用主要因素為Andersen's Behavioral Model中的「需要因素」。居住安排為「僅與親戚或其他非親戚同住」對於「獨居」、「僅與配偶同住」、「與家人同住」的長者在住院、急診醫療服務利用有較高的使用機會。獨居長者可能因健康狀況尚可而獨居，當面對需要因素等健康狀況突然嚴重時，卻已嚴重到需要長期照護介入的情況因而增加「僅與親戚或其他非親戚同住」的長者，因此建議政府衛生單位應更注意獨居長者的日常健康狀況與慢性病的控制，推動數位醫療的介入、推動國民智慧健康照護政策，著重於疾病預防，以避免忽視病情而導致提早成為長期照護的需求對象，以上供政府衛生單位做政策參考。

關鍵字

老年人 ； 居住安排 ； 醫療服務利用

並列摘要

Background: With the extension of the average remaining life of Taiwanese people, lower birth rates and reduced household scales, the ratios of the elderly living arrangements of ‘only with a spouse’ and ‘living alone’ continued to increase. Currently, most studies on living arrangements in relation to the use of medical services focus only on whether a person lives alone or with children. Domestic studies exploring other types of living arrangements remain scarce.
Objective: Explore the impact of the different living arrangements of the elderly in Taiwan on the use of medical services.
Methods: It is a cross-sectional study and uses secondary data analysis of the Taiwan Longitudinal Study on Aging (TLSA) adopted in 2011 by the Ministry of Health and Welfare. With 2,426 elderly over 65 years of age as research participants, the three dimensions of predisposing factors, enabling factors, and need factors served as the research framework. Statistical descriptive statistics and chi-square were used to explore demographic characteristics, health status, and utilization of medical services (hospitalization, hospital ER and western medicine clinic), and then demographic characteristics and health status to explore the impact of elderly living arrangements on medical service utilization through logistic regression.
Results: The average age of the research participants was 76.8 years. The ratio of males to females is similar. In terms of living arrangements, ‘only with others’ accounted for 5.6%, ‘living alone’ accounted for 10.3%, ‘only with spouse’ 18.1% and ‘with family’ accounted for 66%. In terms of medical services utilization situation, ‘hospitalized’ was 23.1%, ‘hospitalized emergency room’ accounted for 25%, and ‘hospitalized Western medicine clinic’ accounted for 94.3% in the last year. Among them, ‘only with others’ had a higher utilization of medical services than other living arrangements. The factors that influence the most in the use of medical services are self-reported health, disease status, activities of daily living, and mental health. The results show that, with demographic characteristics and health status considered, the different living arrangements in the utilization of medical service utilization were not statistically significant. However, if only one looks at the relationship between living arrangements and medical services, it shows that hospitalization utilization of hospitalization and hospital ER utilization ‘only with others’ are higher than in other living arrangements.
Conclusions: It shows that the main factors affecting the utilization of medical services in hospitalization, hospital emergency department, and western medicine clinic service for Taiwanese elderly are "Need Factors" in Andersen's behavioral model. The use of hospitalization and emergency room ‘only with others’ is greater than ‘living alone’ ‘only with spouse’ and ‘with family’. However, for the elderly who can live alone, maybe their health status is fair, and when faced with serious health situations such as need factors, it has become severe enough to require long-term care, increasing the number of ‘only with others’. Therefore, it is recommended that government units pay more attention to daily health status and chronic diseases, promote digital medical care, develop national smart healthcare policy, and focus on the prevention of elderly living alone. To avoid neglecting the disease and leading long-term care early. This is for the policy reference of the government health unit.

並列關鍵字

Elderly ； Living Arrangements ； Health Care Service Utilization

參考文獻

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