影響台灣地區中老年人是否服用安眠用藥的精神壓力來源及相關因素探討

The impacts of different stressors and related factors on sleeping pills taking of middle aged and elderly in Taiwan

賴相君(Hsiang-Chun Lai)

指導教授 ： 廖宏恩

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2008年吳佳璇等學者依國內健保資料研究指出，國人服用安眠藥用量與年齡成正比，且年紀越大用量越大，特別是50歲以上的女性；而2009年Mezick, E.J.等國外學者在針對中老年人族群的研究報告中表示「心理及生理的壓力都是讓人睡不好的原因」，因此若能對於導致睡眠問題的精神壓力來源多一分了解，將可有助於改善策略的擬定，而非僅限於安眠藥的服用。因此本研究旨在探討台灣地區中老年人精神壓力來源之變化，並分析影響中老年人服用安眠用藥的精神壓力來源以及其他相關因素。
本研究採縱貫性次級資料分析，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於1999年（第四波）與2003年（第五波）完成之「台灣地區中老年人身心社會生活長期追蹤調查」資料庫，共篩選出3198名可自答問卷的中老年人，利用SPSS統計軟體進行固定樣本世代追蹤調查分析。統計方法則使用廣義估計方程式（Generalized Estimating Equations ; GEE），分析影響服用安眠用藥的精神壓力來源及其他相關因素。
研究結果發現，在中老年人的精神壓力來源方面，以健康壓力與是否使用安眠用藥有顯著相關；除此之外，性別、現居地、罹患的慢性病數、日常生活活動功能障礙項目數（ADL）亦對中老年人是否使用安眠用藥有顯著影響；換言之，有健康壓力、女性、居住於中部地區、罹患愈多種慢性疾病，以及（ADL）至少有1項(含)障礙的中老年人較會去服用安眠用藥。
因此，希望醫療人員面對有睡眠問題的中老年人應主動協助找出根本原因並提供正確用藥的建議；期待政府應積極連結健康照護與精神照護系統服務，促使慢性病預防及管理服務能更積極的連結發展，期許基層公共衛生單位及社區組織可以主動提供心理諮詢資源，指導中老年人學習早期發現壓力問題，朝身心靈健康邁進。

關鍵字

中老年人 ； 精神壓力來源 ； 睡眠問題 ； 安眠用藥 ； 日常生活活動功能

並列摘要

The results of Wu’s study on Patterns of Benzodiazepines uses and related hazards in Taiwan shown that people’s Benzodiazepines uses increased with age, particularly among female aged 50 and above. In addition, Mezick’s research of 2009 indicated that both psychosocial and physiological stress were related to increased nightly variability in individuals’ sleep duration and fragmentation. More understandings toward the sources of psychological stress that resulting in sleeping problem may help in drawing up a comprehensive plan rather than merely prescribing sleeping pills. Therefore, the purpose of this study is to observe the changes of different psychological stressors of middle aged and elderly in Taiwan and to investigate the impacts of different psychological stressors (i.e., health-oriented, job-oriented, economic-oriented, family affairs-oriented, interpersonal relationship-oriented) and other related factors on their decision to have sleeping pills.
This study carries out a secondary data analysis with a panel dataset. The data resource were from the Year 1999 and Year 2003 “Survey of Health and Living Status of Middle Aged and Elderly in Taiwan” conducted by Population and Health Research Center, Bureau of Health Promotion. We sifted out totally 3,198 people who can self-administer all the questions without family members’ assistance at both surveys as our research objects. We employed SPSS as our statistical software to have statistical inferences by applying Generalized Estimating Equations (GEE).
The results showed that health-oriented stressor, gender, current living region, the number of chronic diseases, and the number of difficulties in Activity of Daily Living (ADL) in the middle aged and elderly were significantly correlated with their decision to take sleeping pills. In other words, middle aged and elderly who were female, or currently living in the middle area of Taiwan, or having more chronic diseases, or having health-oriented stressor, or having at least one difficulty in the ADL measurement, were more likely to take sleeping pills.
Health-oriented stressor was the root cause why middle aged and elderly take sleeping pills. It might imply that there are different levels of services and channels to address this stress issue, not merely prescribing the medicine. For instances, the connection of long-term care system and mental health system in the delivery system, the adequate provision of psychological counseling by local health clinics, and more healthy activities involvement for those who have troubles in sleep, may help the middle aged and elderly overcome the health–oriented stress problem.

並列關鍵字

middle aged ； the elderly ； stressors ； sleep problems ； sleeping pills ； Benzodiazepines ； Activity of Daily Living(ADL)

參考文獻

3.國民健康局（2006）。民國92年台灣地區中老年身心社會生活狀況長期追蹤(第5次)調查成果報告。行政院衛生署國民健康局。

10.紀玫如（2008），「中老年人多重慢性病集群型態與醫療服務使用之相關研究」，國立台灣大學衛生政策與管理研究所博士學位論文。

16.吳惠林(2009)。為失業問題尋根探源。經濟前瞻(122)，p 5-10。

49.姜逸群(2006)。健康促進與生活型態，學校體育雙月刊，16（3），p31-35。

51.曹麗蕙(2009)。強化心靈力量　攜手度過失業低潮。禪天下 (84)，p92-96。