老年人自覺健康狀態及其影響因素

緒言﹕人口高齡化對社會產生的衝擊已使政府的福利制度有所調整，對老年照護投入更多關注。老年人主觀的健康感受比客觀的健康狀態更能影響其生活品質與生活滿意度，甚至可預測死亡率。 研究目的﹕了解老年人自覺健康狀態的分佈情形及其影響因素。 研究方法﹕一.研究對象﹕母群體為臺中市65歲以上居民，依年齡和性別作分層系統隨機取樣的方法，在95%信賴水準上抽樣，共得到472人為研究的樣本，實際完成有效個案446人，男性 255位，女性 191位。二. 研究工具﹕包括基本資料問卷、身體檢查、老年心智功能評估及憂鬱量表，日常活動量表(ADL)及工具操作性日常活動量表(IADL)。統計用邏輯迴歸（Logistic Regression）來進行分析。 結果﹕78.3%的老年人覺得自己的健康情況還好或非常好，21.7%的老年人覺得自己的健康情況不好或非常不好。與自覺健康狀態較差有明顯相關的因素包含﹕性別（女性）、無老伴、教育程度低、生活費用不夠、睡不好、無運動、無煙酒習慣、視力差、有拿拐杖、常看醫師、慢性病數目多、有心臟病、關節炎、糖尿病、高血脂等﹔曾跌倒、身體疼痛、看過神經科或精神科﹔服藥種數多、有吃心臟病藥、止痛藥、安眠鎮靜劑、降血糖藥、降血脂劑、降尿酸藥、促進循環藥物以及中藥或草藥等﹔ADL及IADL分數愈高者﹔檢查結果有精神疾病，特別是有憂鬱症；以及腎功能不正常等等。邏輯迴歸分析得到解釋老年人自覺健康狀態的有意義獨立因素為﹕有憂鬱症、有心臟病、有糖尿病、有身體疼痛、有吃止痛藥、ADL分數愈高者，其自覺健康狀態愈差﹔而就醫間隔較長、有運動、生活費夠用、有抽煙者，其自覺健康狀態不好的比率愈低。以上皆具有統計上顯著意義。 結論﹕本研究發現老年人在身體、心理、生活上皆有強力預測自覺健康狀態之因子。今後之研究及措施應致力於介入這些因子﹐以提高老年人自覺健康的滿意度﹐讓銀髮族能享有高品質生活的晚年。

ABSTRACT Purpose: To determine senior residents'' self-perceived health status and the related factors including demographics, physical conditions, mental and psychological status, living independence and health services utilization. Material and Method: 472 cases was sampled from 54,219 senior residents registered in Taichung city by a stratified systematic random sampling. Personal interview using questionnaires, scale tests and blood examinations was performed. 20 cases died, 6 cases couldn''t complete, and 446 subjects completed the questionnaire. Result: A majority of the elderly (78.3%) had good or excellent perceived health status, while 21.7%of the elderly had poor self-perceived health status. Univariate analysis indicated the poorer self-perceived health status was associated with female gender, single, less education, lower income, poor visual activity, poor mobility, poor sleep, no exercise, no smoking , no drinking, fall and pain history, having depression and other psychological disorder, higher numbers of chronic diseases and medications, more physician visits, impaired renal function and higher scores of ADLs and IADLs. However, multiple logistic regression analysis revealed that only the following variables were associated independently with poorer self-perceived health: depression, suffering from heart disease or diabetes, physical pain, taking analgesics, more physician visits, impaired ADLs, no exercise, lower income, and no smoking. Conclusion: The self-perceived health status in the elderly was related with bio-psycho-social factors as well as functional disability. The further efforts should focus on the intervention of these factors.