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系統識別號 U0026-2008201818300400
論文名稱(中文) 台灣老年人的運動對於醫療利用及長照利用的影響
論文名稱(英文) The effect of physical activity on healthcare utilization and long-term care utilization among Taiwanese elderly
校院名稱 成功大學
系所名稱(中) 公共衛生研究所
系所名稱(英) Graduate Institute of Public Health
學年度 106
學期 2
出版年 107
研究生(中文) 吳姿儀
研究生(英文) Tzu I Wu
學號 T86051086
學位類別 碩士
語文別 中文
論文頁數 66頁
口試委員 口試委員-王榮德
口試委員-王亮懿
指導教授-古鯉榕
中文關鍵字 老年人  運動量  醫療利用  長照利用 
英文關鍵字 elderly  physical activity  healthcare utilization  long-term care utilization 
學科別分類
中文摘要 研究背景:隨著醫療技術的發展,衛生保健服務體系的提升和壽命的延長,老年人口快速增長,導致慢性疾病的發生率隨之上升。根據台灣中央健康保險署統計,2014年65歲以上老年人,每人平均西醫醫療費用相當於其他年齡層的2至3倍之多。隨著老化人口的急遽增加,慢性疾病的盛行、身體功能的障礙,導致醫療費用成長及長期照護需求與日俱增。WHO在2010提到運動是活躍老化的關鍵之一,且許多研究指出運動不僅能減少慢性疾病的發生,有助於減緩基層醫療與長期照護的支出,日本在2005年提出「care prevention」的概念,希望透過運動計畫的介入方式改善老年人的身體功能及日常生活功能,減少並預防老年人使用長照服務的機會。
材料與方法:本研究為世代型追蹤研究,研究目的一探討運動對醫療利用的影響,以2011年台灣地區中老年身心社會生活狀況長期追蹤資料庫(TLSA),串連2012-2013年全民健保資料庫之門診次數、門診點數、住院點數;排除居住在機構者、沒有回答運動題組、ADL≧1、非同意串健保者、在2011年死亡者,最後研究樣本為1799位65歲以上老年人,並連結死因統計檔計算每人每年平均醫療利用點數,使用SAS 9.4軟體進行負二項迴歸及廣義線性模型迴歸分析。目的二為分析老年人的運動型態對長期照護服務利用的相關性,樣本選用2003、2007年兩波的TLSA的資料;排除ADL≧1、在2007年失去追蹤或死亡者,最後研究樣本為1872位65歲以上老年人,套用Andersen Model,將控制變項分為傾向因素、使能因素、需求因素三大類,放進羅吉斯作分析。
研究結果:本研究結果發現,有良好運動習慣的老年人有較高的門診利用,在門診次數上達顯著差異,但在門診點數上則無顯著,而在住院、總醫療點數及長照利用則無顯著差異,並經指數轉換後的迴歸係數大多<1。門診次數:少量運動組是無運動組的1.08倍(P=0.07),積極運動組是無運動組的1.14倍(P=0.01),門診點數:少量運動組是無運動組的1.00倍(P=0.98),積極運動組是無運動組的1.05倍(P=0.38),住院點數:少量運動組是無運動組的0.89倍(P= 0.56),積極運動組是無運動組的0.81倍(P=0.23),總醫療點數:少量運動組是無運動組的0.89倍(P=0.11),積極運動組是無運動組的0.92倍(P=0.25);使用長照服務的勝算:少量運動組、積極運動組分別是無運動組的1.03倍(95%CI=0.552-1.561)、0.92倍(95%CI=0.588-1.444)。
結論:本研究分析老年人的運動型態在醫療利用及長照服務利用的影響,有良好運動習慣的老年人有較多的門診利用,而在住院利用及長照服務利用上較少,雖然沒有統計上的差異,這可能跟運動分組及使用長照服務的樣本數過少有關,然而運動行為及就醫行為可能跟自我健康意識有關,有運動習慣的人可能更具健康意識,醫療利用相對來的多,另外使用長照服務的與否存在一些無法控制的干擾因素,例如政府提供之長照服務項目未能符合個案需求、地區服務資源普及性不夠等,因此並不能直接推論運動對醫療利用或使用長照服務之間的因果關係。
英文摘要 The trend of population aging is increasingly, the prevalence of chronic diseases and physical function disorders have cause increase in medical expenses and long-term care needs. In 2010, WHO mentioned that physical activity is one of the keys to active aging. And many studies have pointed out that physical activity can not only reduce the incidence of chronic diseases, but also help to reduce the cost of primary care and long-term care. This was a cohort study. The first purpose is to examine the prospective association between physical activity and subsequent medical care utilization. Based on the data from the Taiwan 2011 Longitudinal Study on Aging (TLSA), which were linked to the 2012–2013 claims data from the National Health Insurance system. The total sample is 1,799 older adults aged 65 or more. The second purpose is to examine the prospective association between physical activity and subsequent long-term care utilization, the data source is TLSA 2003 and 2007. The total sample is 1,872 older adults aged 65 or more. The results of this study found that older adults with physical active have higher outpatient utilization, there is significant difference in number of outpatient visits, but no significant difference in outpatient medical points. And then, there is no significant difference between physical activity and long-term care service or inpatient medical points, total medical points of older adults, and most of regression coefficients EXP(β) are <1. However, people who are physical active may also be more health conscious and have higher medical utilization. In addition, there are some uncontrollable confounders in the use of long-serving services. So one cannot directly infer causal relationship between physical activity for medical utilization or long-term utilization based on our study results.
論文目次 第壹章 前言 1
第一節、 研究背景 1
第二節、 研究目的 3
第三節、 研究假說 3
第貳章 文獻回顧 4
第一節、 老年人運動概況與測量方法 4
第二節、 老年人運動對醫療利用之影響 7
第三節、 老年人長照服務與利用概況 10
第四節、 老年人運動對長照服務利用之影響 11
第五節、 Andersen Model對長照服務利用之應用 14
第參章 研究設計與方法 15
第一節、 資料來源 15
第二節、 研究對象 16
第三節、 研究設計 19
第四節、 研究變項定義 20
一、 目的一 20
二、 目的二 23
第五節、 統計分析 25
第肆章 研究結果 26
第一節、 2011年TLSA樣本特性 26
第二節、 醫療利用描述性統計 30
第三節、 老年人運動型態與醫療利用統計分析 36
第四節、 2003年TLSA樣本特性 43
第五節、 長照服務利用描述統計 47
第六節、 老年人運動型態對長照利用統計分析 51
第伍章 討論 54
第一節、 本研究主要結果 54
一、 老年人的運動情形 55
二、 醫療利用的相關因素 56
三、 長照利用的相關因素 57
第二節、 本研究優勢與限制 58
一、 研究優勢 58
二、 研究限制 59
第陸章 結論與建議 60
第柒章 參考文獻 61
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