台灣中老年人慢性期中風患者身心健康之退化狀況

The Decline in Physical and Mental Health among Older Chronic Stroke Patients in Taiwan

王思涵(Szu-Han Wang) ； 王俊毅(Jiun-Yi Wang)

《台灣公共衛生雜誌》 32卷4期 (2013/08) Pp. 383-392

https://doi.org/10.6288/TJPH2013-32-04-10

摘要

目標：中風是造成老人身心障礙的主因之一。本研究旨在探討台灣中老年中風患者之身心健康退化狀況。方法：擷取「台灣中老年人身心社會生活狀況長期追蹤調查」1999及2003二個年度資料，依二年度中風病史紀錄將個體分為「無中風病史組」（3,207人）、「新發中風個案組」（170人）及「慢性期中風個案組」（109人），分析三組中老年人身心健康狀態。身心健康指標，包括健康自評、基本／工具性日常生活功能、認知困難、憂鬱傾向及生活滿意度等測量。以成對樣本t檢定、Wilcoxon符號化等級檢定及廣義線性方程式分析三組中老年人在二年度間身心健康的退化及其差異。結果：三組中老年人自1999年其後4年的身體健康狀態均明顯退化，「新發中風個案組」身體功能退化尤其明顯；但「慢性期中風個案組」在身心健康六項指標中，有五項的退化幅度與「無中風病史組」無顯著差異。結論：中風是造成患者身心健康狀態改變的重要因素。而慢性期中風患者在多數的身心健康指標之退化並未比無中風者明顯，顯示中風患者在慢性期後身體功能的退化，雖有部分是中風後遺症導致，但老化可能是更大的影響因素。建議慢性期中風患者可透過各種健康促進活動，延遲老化所帶來的衝擊。本研究將中風對患者的影響初步量化，其結果可作為社會政策擬定及照護資源分配的部分參考。

關鍵字

中老年人 ； 中風 ； 退化 ； 心理健康 ； 身體功能

並列摘要

Objectives: Stroke is one of the main causes of physical and mental disability among the elderly. This study investigated the decline in physical and mental health among older stroke patients in Taiwan. Methods: Subjects who completed interviews as part of the Taiwan Longitudinal Study of Aging in both 1999 and 2003 were included. According to their stroke histories, subjects were grouped into three sub-groups: 3,207 never had a stroke, 170 had a stroke between 1999 and 2003, and 109 had a stroke before 1999. Several measures of physical and mental health were analyzed. These included self-rated health status, basic/instrumental activities of daily living, cognitive disability, depression and life satisfaction. Paired-t tests, the Wilcoxon signed-rank test and generalized estimating equations were used to analyze the decline and the differences in physical and mental health of the three groups. Results: After 4 years of followup, all three groups of older people declined in physical health, especially those subjects who had strokes between 1999 and 2003. There was no difference in the decline in physical and mental health between those subjects who had a stroke before 1999 and those who never had a stroke. Conclusions: A stroke could have a significant impact on the physical and mental health of older people; however, on most health indicators, the decline among chronic stroke patients was not significantly different from that of those who never had a stroke. This suggests that the decline in chronic stroke patients is not only a sequel to a stroke but also a result of aging. Chronic stroke patients could participate in health promotion programs to slow down the impact of aging. This study roughly quantified the impact of strokes on older people and could serve as a reference for social welfare planning and the allocation of health care resources.

並列關鍵字

older people ； stroke ； decline ； mental health ； physical functions

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