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  • 學位論文

社區老人健康行為、健康狀況、生活品質與醫療資源使用情形之探討-- 以高雄縣旗美地區為例

The Relationships Among Health Behavior, Health Status,Quality of Life and Medical Resource Utilization of the Community Elderly-Using Chishan Township,Meinung Township of Kaohsiung County as Example

指導教授 : 張永源

摘要


摘 要 本研究目的在探討社區老人健康行為、健康狀況、生活品質與醫療資源使用情形之關係,採方便取樣橫斷式研究設計方法,以社區老人基本資料、健康行為、WHOQOL-BREF 台灣版生活品質、醫療資源使用結構式問卷及成人健檢資料,訪談215位完成免費成人健康檢查之社區老人。研究結果如下: (1)社區老人平均年齡72.13歲,男性喝酒、吸菸多;喝酒、嚼檳榔、運動和教育程度有顯著相關;吸菸、社區活動與宗教信仰有顯著相關,吸菸、喝酒與就醫類型也有顯著相關。喝酒、嚼檳榔、運動、子宮頸抹片與成人健康檢查有顯著相關,而子宮頸抹片與社區活動及流感疫苗注射也有顯著相關。 (2)社區老人65.6%罹患一種以上慢性疾病,前三名依次為高血壓、糖尿病、心血管疾病。BMI、血糖值女性高於男性,尿酸值則男性較高。不喝酒者、罹病數高、自覺健康狀況差、生活品質較差者急門診看診次數較多。罹病數多、健康檢查異常數多者選擇西醫就診者較多。有接受乳房檢查和社區活動、志工活動者自覺較健康,生活也較快樂。三、社區老人健康相關生活品質滿意度綜合評估為71.4分屬中上,生活品質四個範疇以環境範疇14.56分(指標分數73分)最高,社會關係範疇13.79分(指標分數69分)最低。男性、偶而喝酒、75歲以下、初中以上、有宗教信仰,個人月收入超過1萬元以上、參與社區活動和志工活動者生活品質較佳。四、女性以西醫和民俗療法為就醫型態的較多,全家收入會影響社區老人健康檢查和流感疫苗接種 五、83.26%社區老人身體不適時會看西醫,最近三個月平均2.01次,選擇就醫場所主要考量為離家近(49%)、醫術好(34%)和服務態度好(19%)。去年67%曾接受成人健康檢查、72%接受感冒疫苗注射。 六、自覺健康狀況、自覺生活快樂、教育程度可解釋生活品質生理範疇總變異量40.8%。七、自覺健康狀況、自覺生活快樂、年齡、個人月收入、志工活動、宗教信仰可解釋生活品質心理範疇總變異量45.1%。八、自覺生活快樂、教育程度、年齡、自覺健康狀況和社區活動可解釋生活品質社會關係範疇總變異量32.7%。九、自覺健康狀況、自覺生活快樂、志工活動和運動可解釋生活品質環境範疇總變異量50.0%。十、自覺生活快樂、自覺健康狀況、中醫(就醫類型)可解釋生活品質綜合自評總變異量21.6%十一、自覺健康狀況、罹病數可解釋社區老人急門診次數總變異量17.4%;若加上性別也可顯著預測西醫就醫類型。十二、運動、全家收入和子宮頸抹片可顯著預測是否接受成人健康檢查,子宮頸抹片同時可顯著預測是否接受感冒疫苗注射。 自覺健康狀況、自覺生活快樂是社區老人生活品質共同且重要之預測因子,自覺健康狀況甚至也是急門診看診次數之預測因子。罹病數為急門診看診次數之預測因子,但成人健檢異常數則無法顯著預測社區老人之生活品質和醫療資源使用情形,因此建議應積極推動社區老人衛生教育及健康檢查,以提升正確認知及早期發現早期治療,避免更多醫療資源之浪費。

並列摘要


Objective: The purpose of this study was to explore the relationship among health behavior, health status, quality of life and the medical resource utilization of the community elderly. Methods: A cross-sectional survey with convenience sampling structural questionnaires design was used. The measures included demographic data, health behavior, health status, WHOQOL-BREF Taiwan version, the medical resource utilization, and National Health Insurance (NHI) health examination results .A total of 215 community elders were participated in this study. Data were analyzed by descriptive statistics, Chi-square test, independent t-test, one way ANOVA, Pearson’s correlation, stepwise multiple-regression and logistic regression. Results: The results of this study were as below: 1. The average age of the elders in community was 72.1 years old. Proportion of cigarette smoking and alcohol drinking behavior in male is higher than that in female. There were significantly correlative among alcohol drinking, betel nut chewing, exercise habit, and education level. The correlations were also found in cigarette smoking, community activity and religious belief, as well as in cigarette smoking, alcohol drinking and types of visiting physician. Alcohol drinking, betel nut chewing, exercise habit, cervical smear showed significantly correlative to NHI health examination. Cervical smear examination, community activity were related to flu vaccination. 2. 65.6% of the elders in community had one or more chronic disease; the top three places were hypertension, diabetes and cardiovascular disease. BMI and blood sugar level were higher, and uric acid level was lower in female than male. The elders of non-drinker, multiple diseases sufferer, better health self- rating, and worse quality of life had fewer emergency and outpatient visits. The elders with multiple diseases and abnormality in NHI health examination chose more modern medicine than others. Who accepted the breast examination, community activity, and voluntary activity was aware healthier and happier then others. 3. The satisfaction score of the quality of life about health was 71.4, above middle. The highest score was environmental dimension 14.6 (index score 73) and the lowest score was social-relational dimension 13.8 (index score 69). They had higher quality of life than male, intermittent drinking, age under75 years, above junior high school degree, had religious belief, individual monthly income above ten thousand, and participated in community activity and voluntary activity. 4. More female chose the modern medicine and folk medicine. The NHI health examination and flu vaccination was affected by the family income. 5. 83.3% of elders in community would visit modern medicine when they felt uncomfortable. They had 2 visits average last three months. The major reasons of choosing the institution were near their home (49%), good skill (34%) and service attitude (19%). 67% of elders accepted the adult physical examination and 72% accepted the flu vaccination. 6. The study showed that perceived self-rating health status, self-rating happy on life, educational level were significant predictors of physical dimension with40.8% of the total variance. 7. It showed that perceived self-rating health status, self-rating happy on life, age, individual monthly income, voluntary activity, religious belief were significant predictors of physical dimension with 45.1% of the total variance. 8. It showed that perceived self-rating happiness on life, educational level, age, self-rating health status and community activity were significant predictors of social-relational dimension with 32.7% of the total variance. 9. We found that perceived self-rating health status, self-rating happy on life, voluntary activity, and excise were significant predictors of environmental dimension with 50% of the total variance. 10. The study showed that perceived self-rating happiness on life, self-rating health status and Chinese traditional medicine were significant predictors of self integrated evaluation about Quality of life with 21.6% of the total variance. 11. The study found that perceived self-rating health status and number of chronic disease were significant predictors of emergency and outpatient visits with 17.4% of the total variance. Adding sex factor could predict the visit of modern medicine. 12. The study also showed that perceived excise, family income and cervical smear were predictors of the elders’ NHI health examination. Cervical smear examination is the predictor of the elders’ flu vaccination. Conclusion and Suggestion: The coexisting and prominent predictors on quality of life among the community elderly were “self-rating health status” and “self-rating happiness on life”. Furthermore, “self-rating health status” and “number of disease suffering” were the predictors of visit numbers of the emergency and outpatient services. Number of abnormal items in health examination couldn’t predict the quality of life and the utilization of medical resource. Therefore, intervention of multiple health programs is suggested for community elderly, and it is also helpful to reduce the waste of medical resources.

參考文獻


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被引用紀錄


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吳佳蓉(2015)。中高齡幸福感變遷與相關因素探討─臺灣地區中老年身心社會生活狀況長期追蹤三波調查分析〔碩士論文,臺北醫學大學〕。華藝線上圖書館。https://doi.org/10.6831%2fTMU.2015.00037
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林宜慧(2015)。高雄市大樹區和梓官區中老年人健康狀況研究〔碩士論文,義守大學〕。華藝線上圖書館。https://doi.org/10.6343%2fISU.2015.00093

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