台灣全人口高齡失智症患者事故傷害之探討

研究背景：失智症人口隨著高齡化而有增加的趨勢，過去研究顯示失智症患者的事故傷害發生率較高，然而台灣高齡失智症者事故傷害的研究仍然缺乏。研究目的：比較全台高齡失智症患者和一般高齡族群事故傷害發生率，以及事故傷害原因與損傷性質的差異。材料與方法：使用全民健保資料庫進行回溯性世代追蹤研究，研究對象為2005-2007年期間65歲以上的新發失智症患者，觀察其自發病日起至2012年12月31日期間發生事故傷害事件，計算失智症患者與一般族群的的性別年齡別事故傷害發生率、事故傷害原因及損傷性質的標準化發生率比(SIRR)。結果：失智症患者的標準化事故傷害發生率為一般族群的1.71倍(95% C.I. 1.68-1.74)。因「其他意外事故」(SIRR為2.2, 95% C.I. 2.06-2.33)、「意外墜落」(SIRR=1.92, 95% C.I. 1.88-1.97)、「自殺及自我傷害」(SIRR=1.79, 95% C.I. 1.30-2.36) 入院和一般族群的發生率比顯著較高；反之，因「交通運輸事故」入院的發生率顯著為低(SIRR=0.51, 95% C.I. 0.47-0.55)。失智症患者因「內在器官損傷」(IRR=1.66, 95% C.I. 1.43-1.90)、「挫傷及扭拉傷」(IRR=1.46, 95% C.I. 1.34-1.59)、「骨折和脫臼及截肢」(IRR=1.66, 95% C.I. 1.63-1.70)、「開放性傷口和表淺及血管損傷」(IRR=1.76, 95% C.I. 1.66-1.87)、「燒傷」(IRR=1.55, 95% C.I. 1.31-1.80)、「頭部損傷」(IRR=1.71, 95% C.I. 1.64-1.79)等因素而入院的發生率，均顯著高於一般族群；因事故傷害導致「壓砸傷」而入院的發生率比顯著較低(IRR=0.66, 95% C.I. 0.39-0.97)。結論：高齡失智症患者事故傷害發生率顯著高於一般族群，意外跌墜、自殺及自我傷害的發生率比顯著高於一般族群，除「神經損傷」和「壓砸傷」以外的損傷性質發生率皆高於一般族群，加強高齡失智症患者事故傷害的預防及降低事故傷害損傷嚴重度是當前失智症照顧的重要議題。

關鍵字

失智症；事故傷害:老年人

並列摘要

Background: The number of dementia patients tends to increase with population aging. Previous studies shown the incidence of accidents among dementia patients was high. However, little is known about the accidental injury of dementia patients in Taiwan. Objective: To investigate the incidence of injuries, causes of injury and the nature of injuries among elderly dementia patients compare with general population. Methods: A retrospective cohort study design was conducted using the National Health Insurance Research Database. The participants were newly diagnosed dementia patients who aged 65 years and older between 2005 and 2007. The accidental injury events were observed between the onset date and December 31, 2012. The incidence and standardized incidence rate ratios (SIRR) for accidental injury, causes of injuries and nature of injuries were calculated. Results: The SIRR for accidental injury was 1.71(95% CI 1.68 to 1.74) for dementia patients aged 65 years and older. Patient with dementia had higher risk of other accidents (SIRR 2.2, 95% C.I. 2.06 to 2.33), accidental fall (SIRR 1.92, 95% CI 1.88 to 1.97), suicide and self-harm (SIRR 1.79, 95% CI1.30 to 2.36) and a lower risk of traffic accidents (SIRR 0.51, 95% C.I. 0.47 to 0.55). Dementia patients suffered from burn (SIRR 1.55, 95% C.I. 1.31 to 1.80), internal organ injury (SIRR 1.66, 95% CI 1.43 to 1.90), contusion and strain (SIRR 1.46, 95% CI 1.34 to 1.59), fractures, dislocations and amputations (SIRR 1.66, 95% CI 1.63 to 1.70), open wounds, superficial and vascular injuries (SIRR 1.76, 95% CI 1.66 to 1.87), head injury (SIRR = 1.71, 95% CI 1.64 to 1.79) were significantly higher than the general population. The incidence of hospital admissions due to crush injuries was significantly lower (SIRR 0.66, 95% CI 0.39 to 0.97). Conclusion: Patients with senile dementia have higher risk of accidental injuries. The incidence of accidental falls, suicides and self-harm injuries are significantly higher than the general population. The incidence of the nature of injury except for "nerve injury" and "crush injury" was higher than the general population, highlighting the importance of strengthening the prevention of accidental injury in patients with senile dementia.