台灣地區失能老人使用醫療及長期照顧服務之相關因素探討

The related elements of using medical and long-term caring services for the disabled elderly in Taiwan region.

楊秋萍(YANG CHIOU PING)

指導教授 ： 藍守仁

亞洲大學/健康學院/長期照護研究所在職專班/碩士(2010年)

摘要

根據九十九年第四週內政統計通報，我國65歲以上老人所占比例，98年底已達10.6％
，老化指數為65.1％。隨著老人人口的快速成長，促使醫療及長期照顧服務需求日漸增多
，醫療支出增加，造成全民健保財政及家庭的沉重負擔。
本研究旨在探討台灣地區失能老人使用醫療及長期照顧服務的相關因素。研究資料來源
為行政院衛生署國民健康局人口與健康調查研究中心，民國92年台灣地區中老年身心社會生活狀況長期追蹤(第五次)調查，研究方法為橫斷性次級資料分析，依據失能定義，篩選出有效樣本947名失能老人進行分析，統計方法使用次數分配、百分比之敘述統計、卡方檢定、二元羅吉斯迴歸，分析台灣地區失能老人使用醫療及長期照顧服務之相關影響因素。
研究結果發現，重度失能、過去一年定期或經常量血壓、過去一年有做過血糖檢查、有罹患癌症或惡性腫瘤、有罹患支氣管炎、肺氣腫、肺炎、肺病、氣喘等病、有罹患胃潰瘍或胃病，較會使用住院醫療服務；中度失能、過去一年偶而會量血壓、對自己的健康有感受到很大壓力或經常會有煩惱、同住之家戶成員為其他非親戚、有罹患心臟病、有罹患肝、膽疾病、曾經髖骨骨折，較會使用急診醫療服務；過去一年偶而會量、定期或經常量血壓、過去三年有做健康檢查、有使用身體輔具、有罹患高血壓、罹患疾病總數1~3種，較會使用西醫門診醫療服務；重度失能，較會使用居家護理服務；無同住子女、居住安排個人喜好為住老人安養院，較會使用機構式照護服務。
從本研究結果顯示失能老人之失能程度、罹患慢性病、對自己的健康有很大壓力或經常
會有煩惱、無同住子女等因素，為影響醫療及長期照顧服務使用的主要原因，故而依據上述研究結果提出以下建議以提供政府擬定老人政策之參考：加強慢性病防治衛教宣導，以預防及延緩慢性病發生。加強老人心理衛生輔導，以減輕老人對自己健康的壓力或煩惱。長期照護機構品質管理的重視，可避免因疏於關心照顧、老人虐待，導致營養不良、跌倒，而需使用醫療服務，使失能老人可以得到最適切的全人照顧，減少失能人口，以減少醫療資源支出及浪費。

關鍵字

失能老人 ； 醫療服務使用 ； 長期照顧服務使用

並列摘要

According to the 2010 4th weekly statistics report of Ministry of the Interior, 10.6% of Taiwanese population is 65 years old or older by the end of 2009 with an aging index of 65.1%. With the rapid growth of the senior population, the demand has increased for medical and long-term caring services, and the medical expenses, it has become a heavy burden for the family as well as the health insurance finance.
The purpose of this research is to explore the related elements of using medical and long-term caring services for the disabled elderly in Taiwan region. Information was cited from the research center of Bureau of Health Promotion, Department of Health of R.O.C. (Taiwan) in 2003 the 5th tracking survey report of physical and psychological conditions of elderly social life. This research used the cross-sectional secondary data analysis, based on the definition of disability, 947 effectively cases had been sifted out for analysis, statistics method using frequency distribution, descriptive statistics percentage, chi-square test, binary logistic regression, to analyze the related causes of disabled elderly using medical and long-term caring services in Taiwan region.
Based on research results, it is discovered for those with severe disability, they regularly or frequently measured blood pressure or took blood sugar examination in the past year, likely suffer with cancer, tumor, bronchitis, emphysema, pneumonia, pulmonary disease or asthma, gastric ulcer or stomach troubles, more likely will use hospitalized medical services; for those with moderate disability, they measured blood pressure from time to time in the past year, also felt a great pressure of his/her health or constantly worried about the members or relatives of the family, likely have heart problems, liver, gallbladder diseases, hip fractures, more likely to use emergency medical services; over the past year, who occasionally or periodically or regularly checked blood pressure, did health checks over the past three years, had used physical aids, more likely suffered high blood pressure, or 1 to 3 kinds of diseases, are more likely to use western ambulatory care services; people with severe disability are more likely to use home care services; those who did not live with children and who made their own living arrangements for domestic nursing homes are more likely to use institutional care services.
The results from this study show that the disability level, chronic disease, stresses due to concern for their own health or other things, not living with children and other factors of disabled elders are the main reasons affecting the usage of medical health and long-term cater. Therefore, based on the above findings, the following suggestions are recommended in order to provide a reference for formulating government policy of the elders: To strengthen the advocacy of chronic disease prevention in order to preclude and delay the occurrence. It is necessary to strengthen mental health counseling for elders in order to mitigate the elders’ concern for their own health and other things. Pay attention to the long-term care institution quality management to avoid overloading of health care services because of neglect of care and abusing elders which leads to malnutrition and falls. Hence, disabled elders can be taken care with the most appropriate holistic way, the population of disabled elders can be reduced and the spending and waste of medical resources also can be reduced.

並列關鍵字

disabled elderly ； use of medical service ； use of long-term caring service

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