紀彣宙CHI,WEN-CHOU吳兆華WU,CHAO-HUAWU職能治療學系碩士班2026-03-242025/8/1220252025/7/29https://handle.ncl.edu.tw/11296/98jq7jhttps://scholars.csmu.edu.tw/handle/123456789/6493研究目的：本研究旨在分析台灣失智症患者三年內生活自理的變化趨勢，並檢視可能影響此功能改變的因素，包括人口學、臨床與環境變項。我們特別關注患者於初次與三年後鑑定中WHODAS 2.0生活自理領域（對應基本日常生活活動）的表現分數，並探討年齡、性別、教育程度、居住型態（社區獨立/協助與機構）及臨床失智評估量表(CDR)等與自理功能衰退之關聯。研究方法：採用回溯性縱貫設計，資料來自2012至2018年間台灣身心障礙鑑定資料庫。納入條件為年齡 ≥ 65歲，診斷為神經系統及精神心智功能障礙（含失智症ICD診斷碼及CDR評分），且具有初次及三年後的兩次鑑定紀錄。評估工具為 WHO WHODAS 2.0 成人版，以表現分數衡量功能狀態，其中生活自理領域反映基本日常生活能力。將WHODAS分數標準化為百分比（分數越高代表障礙越嚴重），並以廣義線性模型分析年齡、性別、教育程度、居住型態、CDR等變項對生活自理功能變化之影響。結果與討論：失智症患者在三年期間整體功能顯著退化，WHODAS 2.0各領域（認知、行動、社交及生活自理等）障礙分數均明顯提升，符合失智症病程中日常生活能力下降的特徵。迴歸結果顯示，高齡與較重失智程度 (CDR) 為生活自理功能退化的主要預測因子，年齡越大或CDR等級越高者，其三年後生活自理障礙分數顯著增加。性別與教育程度對生活自理變化無顯著影響 (p > 0.01)。居住型態對功能維持具重要影響，社區獨立或協助居住患者之生活自理功能優於機構住民，顯示社區居住環境有助於延緩功能退化。。結論：本研究結果顯示失智症患者功能退化主要與年齡增長及失智程度加深相關，而性別與教育程度影響不顯著。居住於社區與較佳的自理功能相關，相較於機構照護，此發現提示在長照政策與資源分配上，應優先針對高齡和重度失智者提供早期介入與支持，同時強化社區復健與日間照護等在地服務。透過分析台灣身心障礙資料，本研究提供了在地化證據基礎，可供臨床與政策制定者作為支持失智症患者生活自理的參考依據。Objective: To evaluate three‑year changes in self‑care function among older adults with dementia in Taiwan and to identify demographic, clinical, and contextual predictors of long‑term functional decline.Methods: A retrospective longitudinal design was employed using data from Taiwan’s Disability Identification Database (2012–2018). Inclusion criteria included age ≥65 years, diagnosis of neurological or mental disorders (including dementia ICD codes with available CDR scores), and completed assessments at baseline and three-year follow-up. Functional status was assessed via the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) adult version, with scores standardized to percentages (higher scores indicate greater impairment). Generalized linear models were used to evaluate predictors of changes in self-care performance, with independent variables including age group, sex, education, living arrangement, CDR level, and initial assistance needs.Results and Discussion: Dementia patients demonstrated significant functional decline over three years, with increased disability scores across all WHODAS 2.0 domains, including cognition, mobility, social interaction, and self-care, consistent with typical dementia progression. Regression analyses identified older age and higher CDR levels as primary predictors of increased self-care disability; specifically, each one-level increase in CDR corresponded to a 12–13 point rise in disability score (p < 0.001). Sex and education level did not significantly impact self-care decline (p > 0.01). Living arrangement significantly affected functional preservation, with community-dwelling (independent or assisted) patients showing better self-care outcomes than institutionalized residents, suggesting community settings support functional maintenance.Conclusion: Functional decline among older adults with dementia is strongly associated with aging and disease severity. Living in the community, either independently or with assistance, is linked to better preservation of self-care abilities compared to institutional settings. These findings highlight the importance of early intervention and community-based support for older adults with moderate to severe dementia. By leveraging a comprehensive national dataset, this study provides localized evidence to inform clinical practice and long-term care policy planning in Taiwan.失智症日常生活活動WHODAS 2.0功能退化台灣DementiaActivities of Daily LivingFunctional DeclineTaiwanthesis