台灣中老年人的健康行為、服藥遵從態度與醫療資源耗用之關聯

人口逐漸高齡化，中老年人口比例增加，中老年人的健康問題與服藥狀況較繁複，服藥遵從態度、健康行為與健康狀況與醫療資源耗用息息相關。瞭解中老年人的健康行為、服藥遵從態度，將有助於介入適當的健康促進措施。是故，本研究目的係為探究台灣中老年人的健康行為、服藥遵從態度及與醫療資源耗用之關聯。研究方法以衛生福利部國民健康署「台灣中老年身心社會生活狀況長期追蹤調查」，採橫斷式次級資料分析，採用2007年調查資料之個案為研究樣本，總樣本數為4535人。分析台灣中老年人健康行為、服藥遵從態度與醫療資源耗用的分布情形及其相互之關聯。使用SPSS for Windows 19.0統計套裝軟體進行描述性與推論性統計分析。研究結果過去一年裡住院總次數與是否有吸菸、喝酒、運動習慣、生活調適、及服用保健營養品相關；過去一年裡住院總天數與是否有吸菸、喝酒、吃檳榔、運動習慣、定期健康檢查、飲食控制、生活調適及服用保健營養品相關；過去一年裡急診總次數與是否有吸菸、喝酒、吃檳榔、運動習慣、定期健康檢查、飲食控制、生活調適相關；過去一個月內西醫門診總次數與是否吸菸、喝酒、定期健康檢查及服用保健營養品相關；過去一個月內中醫門診總次數與是否吸菸、飲食控制及服用保健營養品相關。而服藥遵從態度與醫療資源耗用無顯著相關。過去一年裡住院總次數/總天數、過去一年裡急診總次數、過去一個月內西醫門診總次數與年齡及婚姻狀況相關；過去一年裡住院總次數/總天數、過去一年裡急診總次數、過去一個月內西醫門診總次數、過去一個月內中醫門診總次數與自覺健康狀況、罹患疾病、日常活動情形、憂鬱程度相關。年齡較小者較有把握能遵照醫囑服藥( P＜.01) ；男性較有把握能遵從醫囑服藥( P＜.01)；有偶者較有把握能遵從醫囑服藥( P＜.001)。是否有吸菸、吃檳榔、運動習慣、定期健康檢查、飲食控制、生活調適、服用保健營養品數目與服藥遵從態度有關，且達到統計上顯著差異( P＜.05)。自覺健康狀況、日常活動情形、工具性日常活動、認知功能及憂鬱程度與服藥遵從態度有關，且達到統計上顯著意義( P＜.01)。結論與建議醫療資源耗用情形與健康行為及健康狀況有關；健康行為愈佳，服藥遵從態度也較佳。建議可推廣健康行為促進之衛教或活動，並教導民眾正確的用藥觀念，期望有效提升台灣中老年人健康狀況並減少醫療資源耗用。

關鍵字

中老年人；健康行為；服藥遵從態度；醫療資源耗用

並列摘要

Gradually aging and an increase in the proportion of the elderly population, health problems and medication status in the elderly are more complicated. Medication compliance attitudes, health behaviors and health status and medical resource utilization are closely related. Understanding the health behavior and medication compliance attitude of the elderly will help to promote health. Therefore this study aims to explore the relation of health behaviors, medication compliance attitudes and medical resource utilization of the elderly in Taiwan. Methods The data of "Survey of Health and Living Status of the Middle Aged and Elderly in Taiwan" investigated by "Health Promotion Administration, Ministry of Health and Welfare" was used. We designed a cross – sectional, secondary data analysis study, and used the case of the 2007 survey data for the study sample. The total sample size was 4535 people. The distribution of the healthy behaviors, medication compliance attitudes and medical resource utilization of the elderly in Taiwan was analyzed with descriptive and inferential statistical analysis using SPSS for Windows 19.0 statistical software package. Results The total number of hospitalizations in the past year is associated with smoking, drinking, exercise habits, life adjustment, and taking nutrition supplements; the total number of days of hospitalization in the past year is associated with smoking, drinking, chewing betel nuts, exercise habits, regular health checks, diet modification, life adjustment and taking nutrition supplements; the total number of emergency visit in the past year is associated with smoking, drinking, chewing betel nuts, exercise habits, regular health checks, diet modification, life adjustment; the total number of physician visits in the past month is associated with smoking, drinking, taking regular health checks and taking nutrition supplements; the total number of Chinese medicine clinic visit in the past month is associated with smoking, diet modification and taking nutrition supplements. The medical resource utilization was not significantly associated with medication compliance attitude. The total number of hospitalizations in the past year / total number of days of hospitalization in the past year, the total number of emergency visit in the last month and the total number of physician visits are associated with age and marital status; the total number of hospitalizations / total number of days of hospitalization in the past year, the total number emergency visit in the past month, the total number of physician visits in the past month, the total number of Chinese medicine clinic visit are associated with health status, suffering from diseases, daily activities situations and depression. Younger people are more likely to follow the prescription (P <.01); males are more likely to follow the prescription (P <.01); those with a spouse are more likely to follow the prescription (P <.001). Medication compliance attitudes are significantly associated with smoking, chewing betel nuts, exercise habits, regular health checks, diet modification, life adjustments, the number of nutrition supplements (P <.05). Medication compliance attitudes are significantly associated with perceived health status, activities of daily living situations, instrumental activities of daily living, cognitive function and depression (P <.01). Conclusions and Recommendations The medical resource utilization is associated with health status and health behaviors. The better healthy behaviors the better are medication compliance attitudes. Promoting health behavior or education activity and teaching people the correct medication perceptions are suggested and help to improve the health status of the elderly in Taiwan and reduce medical resource utilization effectively.