老人憂鬱與失能過程及死亡之間的關係

The influences of depression on disablement process and mortality among elderly in Taiwan

呂云丞(Yun-cheng Lu)

指導教授 ： 葉志嶸

中山醫學大學/健康管理學院/公共衛生學系碩士班/碩士(2011年)

https://doi.org/10.6834/CSMU.2011.00173

摘要

目的：瞭解憂鬱對失能過程的影響。
方法：研究樣本來自1999、2003、2007的年「台灣中老年身心社會生活狀況長期追蹤調查」的資料。分析變項包括性別、年齡、教育程度、罹病狀況、身體功能、ADL、IADL等，並以CES-D抑鬱量表來界定憂鬱傾向，刪除遺漏值後，分析樣本數為2,616 人。
結果：年齡越大、女性、教育程度低、疾病數、身體功能受限、失能情形嚴重度越高的老人，其憂鬱情況較高。男性高血壓、中風、疾病數與憂鬱產生交互作用，女性糖尿病與次閾值憂鬱具有交互作用，而加速失能過程。身體功能受限與不同憂鬱類型間會產生交互作用而增加ADL失能的程度。身體活動功能受限至死亡階段之中介因子研究，男性方面，身體功能受限會增加死亡風險，而ADL、IADL失能皆為身體活動功能受限至死亡之中介因子。女性則未發現明顯之中介效應。
結論：憂鬱症在失能過程各個階段，可加速身體功能受限及失能之發展過程。對於老人憂鬱症狀之處理，可預防生活品質惡化或維持較佳之生活品質。

關鍵字

老人 ； 憂鬱 ； 失能過程

並列摘要

Objective: The purposes of this study were to investigate the effect of depression in the disablement processes.
Method: Three waves’ data (year 1999, 2003 and 2007) of survey of Health and Living Status of the Middle Aged and Elderly in Taiwan was used for this study. Variables of personal characteristics, health status, self-perceived health status, activity of daily living, instrumental activity of daily living, chronic disease status. Depressive symptom was measured by Center for Epidemiological Studies Depression Scale (CES-D). Sample size included in this analysis was 2616.
Results: Age, female, lower education level, chronic disease number, physical dysfunction, and disability, were correlated with depressive symptom. In men, the effect of hypertension and stroke on disablement process, were worsened in depression subjects. In women, diabetes was significantly correlated with disablement process and worsened in depression subjects. Physical function limitation predicted further IADL and ADL disability, and interact with depression to worsen the risk of disability. For mediating effect study, in male, IADL and ADL disability will mediate the process from physical function limitation to mortality. In female, there is no significant mediating effect of IADL and ADL disability.
Conclusion: Depression is an important effect modifier in the disablement process, from pathology stage, physical function stage, , to disability stage. The management of depression will be helpful to maintain the quality of life in the elderly.

並列關鍵字

Elderly ； Depression ； Disablement process

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