台灣老人照顧方式影響因素之探討

Analysis of the Determinants of Needing Care or Needing Formal Care in elderly Taiwanese

賴采滿(Lai Tsae-Man)

指導教授 ： 蔡仲弘

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

背景與目的：老化增加疾病罹患、行動失能及認知障礙的風險。嚴重時，需依賴他人照顧。本研究的目的在探討老人成為需照顧(入住機構或僱人照顧或由家人照顧)或需正式照顧(入住機構或僱人照顧)的預測因子。
方法：本研究分析國民健康局「中老年身心社會生活狀況長期追蹤調查」1999及2003年的訪談資料。以二元邏輯迴歸法(Binary logistic regression analysis )分析老人成為需照顧或需正式照顧的關聯因子。以p<0.05界定顯著意義。
結果：結果顯示(a)「認知障礙」(MMSE≤4分，OR =2.69, 95% CI =1.73-4.16, p<0.001；MMSE 5-6分，1.82, 1.17-2.81, p<0.01)，「年齡≥80歲」(2.57, 1.80-3.67, p<0.001)，「過去一年曾跌倒」(1.66, 1.17-2.37, p<0.005)，「過去一年曾住機構」(1.78, 1.19-2.65, p<0.005)，及「自評健康不好」(1.45, 1.06-1.98, p<0.05)等為老人成為需照顧的預測因子。(b)迴歸模式不含「日常生活功能」(Activities of Daily Living, ADL)變項時，「過去一年曾住機構」(8.55, 1.03-71.1, p<0.05)，「≥80歲」(2.67, 1.70-4.19, p<0.001)，「認知障礙」(MMSE≤4分, 2.51, 1.41-4.48, p<0.01；MMSE 5-6分, 2.63, 1.50-4.62, p<0.001)及「自評健康不好」(1.62, 1.06-2.49, p<0.05)等為可自我照顧或由家人照顧老人需正式照顧的顯著預測因子；但當模式加入「日常生活功能」變項時，「過去一年曾住機構」及「自評健康不好」兩變項則呈不顯著。(c)「日常生活功能惡化」是非正式照顧(由家人照顧)老人需正式照顧唯一顯著預測因子(5.58, 1.50-20.8, p<0.01)。
結論：髙齡、認知不良及日常生活功能障礙或日常生活功能惡化是台灣老人成為需照顧或需正式照顧的主要影響因子。過去一年曾住機構及自評健康不好是次要因子，因日常生活功能障礙才導致老人需正式照顧。結果顯示如何預防失能與認知障礙，為推遲老人需照顧或需正式照顧的政策規劃重要策略目標。本研究為首次以追蹤資料分析台灣老人成為需照顧或需正式照顧的預測因子，結果可供長期照護政策規劃之有力依據。

關鍵字

老人 ； 非正式照顧 ； 正式照顧 ； 長期照護 ； 失能

並列摘要

Background and objective: As we age, the risk of illness, functional disability and cognitive impairment increases. In severe cases, one become dependent and would rely on others for care. Predictors of needing care have been under intensive investigation in Western countries, but have not been robustly examined in Taiwan. This study aimed to examine the predictors of needing care or needing formal care in elderly Taiwanese.
Methods: This study analyzed the1999 and 2003 data “Survey of Health and Living Status of the Elderly in Taiwan”. Subjects of the first cohort aged 70 years or older in 1999 were the subjects of this analysis. Binary logistic regression analysis was used to determine the predictors of needing care or needing formal care among those who survived in 2003. Statistical significance was accepted at alpha = 0.05.
Results: Results showed that “cognitive impairment” (MMSE≤4 score) OR =2.69, 95% CI =1.73-4.16, p<0.001 or (MMSE 5-6 score) 1.82, 1.17-2.81, p<0.01, “old age (≥80 y)” 2.57, 1.80-3.67, p<0.001, “fell” 1.66, 1.17-2.37, p<0.05, “prior nursing-home stay” 1.78, 1.19-2.65, p<0.05, “poor self-rated health” 1.45, 1.06-1.98, p<0.05 significantly predicted needing care. In a model without including "functional impairment”, “prior nursing home stay” 8.55, 1.03-71.1, p<0.05 “≥80years” 2.67, 1.70-4.19, p<0.001, “cognitive impairment” (MMSE≤4 score) 2.51, 1.41-4.48, p<0.01; (MMSE 5-6 score) 2.63, 1.50-4.62, p<0.001 and “poor self-rated health” 1.62, 1.06-2.49, p<0.05, significantly predicted needing formal care; When the model included "functional impairment”, “prior nursing home stay” and “poor self-rated health” became not significant. These results suggest that “functional disability” is the major predictor of needing informal and formal care.
Conclusion: Old age, cognitive impairment and functional disability are the major determinants of initial needing care or needing formal care in elderly Taiwanese. Prior nursing home stay and poor self-rated health are secondary determinants. These results suggest that prevention of disability and cognitive impairment are the key in delaying the onset of needing care in elderly. Results of this study are valuable to policy planners in designing effect strategies to delay the onset of needing care.

並列關鍵字

Elderly ； Needing care ； Formal care ； Long term care ； Functional disability

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