台灣老年人體位狀況對醫療利用之影響

The Effect of Anthropometric Status on Utilization of Health Care Services among the Elderly in Taiwan

王佳雯(Chia-Wen Wang)

指導教授 ： 黃英家

亞洲大學/健康學院/健康管理研究所/碩士(2008年)

摘要

背景：過重與肥胖盛行率在65歲以上老年人中正日益成長，過輕之比例雖小，卻伴隨更高的死亡率。老年人過重、肥胖或過輕都不是健康的體位，是造成許多老年人嚴重疾病及失能之重要危險因素。
研究的目：探討老年人體位狀況對醫療利用之影響，並瞭解體位狀況之相關危險因素。
方法：以全國代表性之2001年「國民健康訪問調查（NHIS）」年滿65歲以上者為研究對象，共1,290人。以描述性統計、卡方檢定、Cramer’s V係數、列聯相關，以及邏輯斯迴歸進行分析。
結果：研究結果顯示75歲以上、無個人月平均收入、至少有一項日常生活活動功能（ADL）障礙，及無罹患合併症項數顯著傾向有過輕體位（BMI ＜ 18.5 kg/m2）；65-74歲、不識字，及罹患1項、2項或3項以上合併症顯著傾向有過重（24 ≦ BMI ＜ 27 kg/m2）體位；65-74歲、女性，及罹患2項或3項以上合併症顯著傾向有肥胖體位（BMI ≧ 27 kg/m2）。與正常體位（18.5 ≦ BMI ＜ 24 kg/m2）相比，過去一年內過輕（p ＜ .01）、過重（p ＜ .01）及肥胖（p ＜ .05）者較易利用急診；過去一個月內過重者較易利用西醫門診（p ＜ .05）。
結論：過輕對老年人之醫療利用影響並不亞於過重及肥胖體位，建議衛生主管機關訂定一套老年人之體位評估指標、加強宣導老年人對健康體位之認知，並將異常體位納入健保給付項目之一，俾以減少相關的醫療利用，達到體位防治之最終目標。

關鍵字

體位狀況 ； 醫療利用 ； 身體質量指數 ； 老年人 ； 台灣

並列摘要

Background: The prevalence of overweight and obesity are growing progressively among the elderly (over 65 years). Underweight, even though it occurs in only a tiny fraction of the population, is actually associated with more excess deaths. Overweight, obesity, or underweight are not healthy body weight, which are both important risk factors for severe diseases and disability in the elderly.
Objectives: To analyze the effect of anthropometric status on utilization of health care services by elderly, and understand its related risk factors.
Methods: Data were drawn from the 2001 National Health Interview Survey (NHIS), overing a 1,290 sample representative of the non-institutionalised Taiwanese population aged 65 years and over. Analyses were performed using descriptive statistics, Chi-square test, Cramer’s V coefficient, contingency correlation, and logistic regression.
Results: The results showed individuals aged older than 75, not possessing personal monthly income, had at least one difficulty in activities of daily living (ADL), and with none of comorbidities were significantly more likely to be underweight (BMI ＜ 18.5 kg/m2). In individuals aged 65 to 74 years, illiterate, and with one, two, or above three of comorbidities were significantly more likely to be overweight (24 ≦ BMI ＜ 27 kg/m2). In individuals aged 65 to 74 years, women, and with two or above three of comorbidities were significantly more likely to be obesity (BMI ≧ 27 kg/m2). Compared with normal weight (18.5 ≦ BMI ＜ 24 kg/m2), the elderly with underweight (p ＜ .01), overweight (p ＜ .01), and obesity (p ＜ .05) were more likely to use emergency department services in the past one year. The elderly with overweight (p＜ .05) were more likely to visit hospital outpatient services than normal weight in the past one month.
Conclusion: The effect of underweight on utilization of health care services could stand comparison with overweight and obesity among elderly. Thus, this study recommended that government to set one of anthropometric measurement indicator for elderly, to promote them recognized which was healthy body weight, and to connect abnormal weight status into health insurance. Finally, the prevention of policies chould reduce some related health care utilization, and successfully reach the goal of protecting elderly from abnormal weight status.

並列關鍵字

anthropometric status ； health care services utilization ； BMI ； elderly ； Taiwan

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