縱貫性探討糖尿病對社區老人身體活動功能及死亡之影響

摘要國人十大死因已由急性傳染病轉變為慢性疾病，慢性疾病之永久性、遺留殘障、需長期照護等特徵使得我們關心健康的層面應不再只侷限於疾病之有無，而應延伸至疾病帶來之後果，故本研究主要目的在於縱貫性探討社區老人有無罹患長期性糖尿病身體功能之時間變化，影響身體失能過程以及死亡之因素。本研究是以居住於高雄市三民區65歲以上社區老人為研究樣本，樣本分別糖尿病組(DM組，N=153)與非糖尿病組(非DM組，N=1107)，主要以中文版老人多元功能評估問卷(CMFAQ)於老人家中進行面對面訪視，訪視期間自1994年至2002年，每2年訪視一次，共5個訪視時間點，訪視內容包含老人社會資源、經濟狀況、精神健康狀況、身體健康狀況及日常活動能力等。本研究除面訪資料外，並配合行政院衛生署台灣地區死因資料檔，利用邏輯式迴歸分析社區老人存活情形，以及影響社區老人存活的影響因素。研究結果為影響社區老人身體日常活動能力(PADL)的顯著因素有時間、年齡、糖尿病、是否獨居與聽力狀況，顯示隨著追訪時間愈長久、年齡愈高、罹患糖尿病、有與人同住與聽力狀況愈差之社區老人其PADL值愈差；影響社區老人工具性日常活動能力(IADL)之顯著因素有時間、年齡、糖尿病、教育程度、視力狀況、聽力狀況、SPES與PQ量表，顯示時間愈長久、年齡愈高、罹患糖尿病、教育程度愈低、視力與聽力狀況愈差、SPES回答愈負面與PQ量表答錯題數愈多之社區老人其IADL值愈差。另攸關社區老人存活狀況，DM組之死亡率比非DM組死亡率高，而影響社區老人存活之顯著因素有年齡、性別、糖尿病、感到孤單與PADL值，顯示年齡愈高、性別為男性者、罹患糖尿病、愈常感到孤單與PADL值愈低之社區老人愈易死亡。依據本研究結果得知，年齡、糖尿病會影響社區老人身體功能，使其身體功能降低，而年齡高、罹患糖尿病與低身體功能會進一步影響社區老人之存活狀況，故在醫療資源、政府經費、人力有限的今日，關心老人族群身體狀況與存活時，應先特別注意有糖尿病及以上特徵之老人。\r 關鍵字：糖尿病、老人多元功能評估

關鍵字

糖尿病；老人多元功能評估

並列摘要

英文摘要 Objective—The underlying cause of death in Taiwan has translated from chronic disease to acute disease. Chronic disease is perpetual, remaining deficient et ,and we should take care the consequence of disease .The major purpose of this study is three-fold：1) to explore time effective 2) to examine effective factors associated with physical capability 3) to evaluate effective factors associated with death among elderly people with diabetes residing on the community . Research Design and Methods—The study sample was separated into diabetes group (153) and non-diabetes group (1107) from San-Min, Kao-hsioung. The survey data were collected at the elderly home by the CMFAQ from 1994 to 2002 and included social source, economical source, mental health, physical health and daily activities ability. Besides, we use logistic regression to conduct the effective factors associated with death among elderly people residing on the community. Results—The significant factors affecting the elderly PADL were time, age, diabetes, living alone and hearing condition. The elderly people’s PADL was worse if they were older, having diabetes, living with others, and having worse hearing condition by the following time. The significant factors affecting the elderly IADL were time, age, diabetes, education, vision and hearing condition, SPES and PQ. The elderly people’s IADL was worse if they were older, having diabetes, lower education, having worse vision and hearing condition, negative mental health and cognitive by the following time. The mortality rate was higher in elderly people with diabetes than without diabetes. The significant factors affecting death in the elderly people were older age, male, having diabetes, lonely and lower PADL. According to the results, older age and diabetes affected the physical ability in the community elderly. Older age, diabetes and lower physical ability affected the survival of the community elderly. Therefore, we should pay more attention on the elderly people’s health status and survival condition in this limited medical resource society. Keyword: Diabetes, CMFAQ