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系統識別號 U0026-2106201915564700
論文名稱(中文) 慢性病對失能變化之長期追蹤
論文名稱(英文) Physical disability trajectories after chronic conditions: a retrospective cohort study in Taiwan
校院名稱 成功大學
系所名稱(中) 老年學研究所
系所名稱(英) Institute of Gerontology
學年度 107
學期 2
出版年 108
研究生(中文) 周杰穎
研究生(英文) Chieh-Ying Chou
學號 TC6064071
學位類別 碩士
語文別 英文
論文頁數 53頁
口試委員 指導教授-邱靜如
召集委員-官大紳
口試委員-楊宜青
中文關鍵字 失能軌跡  常見慢性病  台灣中老年人 
英文關鍵字 physical disability  trajectory  chronic condition  middle-aged and older Taiwanese 
學科別分類
中文摘要 背景: 失能為罹患慢性疾病後的併發症之一,且佔絕大多數的醫療保健支出。儘管過去許多研究已經探討慢性病對於失能的影響,但是對於亞洲地區中老年人族群,同時探討多個疾病診斷後之失能程度與失能變化之比較至今仍無。而同時比較罹患慢性病後之平均失能分數和失能變化速度軌跡及探討其相關可改變的因子的影響,可以幫助醫療主管機關對較失能的慢性病採取預防及介入的措施以及更有效地分配醫療資源。
目地: 同時比較多個慢性病診斷後之平均失能分數及失能變化速度軌跡,並探討社會人口學及健康行為相關因子的影響力。

方法: 本研究使用1996、1999、2003、2007及2011年共五波之台灣地區中老年身心社會生活狀況長期追蹤調查(TLSA)資料。在此五波的世代追蹤期間,於1996年自述有慢性病診斷及於追蹤期間新診斷慢性病的受訪者均納入分析,最後研究樣本包含1,435位高血壓、570位糖尿病、915位心臟病、277位中風、192位癌症、614位肺部疾病及1,193位關節炎等七種慢性病的受訪者。社會人口學變項包含初診斷年齡、性別與教育程度,健康相關因子為各波共病的數目及憂鬱狀態。失能指標為日常生活功能(ADL)、工具型日常生活功能(IADL)及基本活動能力(Strength and Mobility Activities)三項總分的加總共17分。本研究使用多層次模型(MLM)分析來描繪罹病後的失能軌跡,因此分析方式擁有處理資料遺漏值及控制隨時間改變之共變數等優點。

結果: 在常見的七種慢性病失能軌跡中發現(1)診斷當下以中風(β中風 = 8.104)、癌症(β癌症 = 3.693)及糖尿病(β糖尿病 = 2.887)之失能分數最高(2)在罹病後失能穩定上升的速度以中風(β中風*罹病時間 = 0.203)、肺部疾病(β肺部疾病*罹病時間 = 0.200)及心臟病(β心臟病*罹病時間 = 0.155)最大(3)罹患糖尿病(β糖尿病*罹病時間2 = 0.014)、癌症(β癌症*罹病時間2 = 0.013)及高血壓(β高血壓*罹病時間2 = 0.010)之中老年人其失能速度之變化會隨著罹病時間增加導致失能變化越快的現象(越後期越失能)。在各個慢性病中,社會人口學變項分別解釋20.3-35.2%的初診斷失能分數變異量及17.5-41.4%的診斷後失能軌跡變化變異量,而在控制社會人口學變項及共病後,憂鬱狀態分別解釋了39.9-73.6%的初診斷失能分數變異量及37.9-100%的診斷後失能軌跡變化變異量。

結論: 此研究結果描繪出不同慢性病診斷後之失能分數與罹病後失能變化。此外,減少憂鬱狀態對於避免罹病後失能分數增加的趨勢有保護的作用。
英文摘要 Background: Disability is one of the chronic disease's complication and also accounts for vast majority of healthcare expenditure. Although previous studies have explored the effect of chronic conditions on physical disability, but little is known for the levels and rates of change in physical disability after common chronic condition diagnosis in middle-aged and older adults in Asian population. Comparing the levels and rates of change of physical disability among common chronic condition simultaneously and investigating the influence of associated modifiable factors that leading to physical disabilities can help health authority put more emphasis on disease prevention and intervention toward more disabled chronic condition and allocate the medical resources more efficiently.
Aim: To ascertain the average levels of and rates of change in development of disability after the diagnosis of different chronic conditions, and examine the roles of socio-demographic and health-related correlates in different chronic conditions.

Method: We used datasets in the 1996, 1999, 2003, 2007 and 2011 interview waves from the Taiwan Longitudinal Study on Aging (TLSA) representing Taiwanese cohort aged over 50 years old. Self-reported chronic conditions in 1996 and newly diagnosed chronic conditions during follow-ups were included for final analysis, yielding sampling of 1,435 participants with hypertension, 570 with diabetes mellitus, 915 with heart diseases, 277 with stroke, 192 with cancer, 614 with lung diseases and 1,193 with arthritis. Socio-demographic variables included age at initial diagnosis, gender and education level. Health-related correlates included number of comorbidity and depression status at each wave. Physical disability scores were the sum of 17 dichotomous scores for the ADL, IADL and strength and mobility activities. Multilevel modeling (MLM) was used to depict physical disability trajectories after disease diagnosis due to its flexibility for managing missing data and capacity to control for time-varying covariates.

Results: Among the seven chronic conditions we examined, the result showed that (1) physical disability score is highest in stroke (βstroke = 8.104), followed by cancer (βcancer = 3.693) and diabetes (βdiabetes = 2.887) at initial disease diagnosis. (2) the linear rate of change of physical disability after disease diagnosis is highest in stroke (βstroke*time = 0.203), followed by lung disease (βlung disease*time = 0.200) and heart disease (βheart disease*time = 0.155). (3) the quadratic rate of change of physical disability after disease diagnosis is highest in diabetes (βdiabetes*time2 = 0.014), followed by cancer (βcancer*time2 = 0.013) and hypertension (βhypertension*time2 = 0.010). Socio-demographic variables explained 20.3-35.2% and 17.5-41.4% of the variances in physical disability intercept and change and over time, respectively. After controlling for socio-demographic and comorbidity, depression status accounts for 39.9-73.6% and 37.9-100% of the variances in physical disability intercept and change and over time.

Conclusions: Findings from this study depicted the physical disability at initial disease diagnosis and changing over time among different chronic condition. In addition, minimizing depression status may have protection effect for preventing the trend of increased physical disability.
論文目次 目錄
中文摘要 I
英文摘要 III
誌謝 V
目錄 VI
表目錄 VIII
圖目錄 IX
主文 1
Chapter I. Introduction 1
1.1 Background 1
1.2 Aim 3
Chapter II. Literature Review 4
2.1 Disability Development in Older Adulthood 4
2.2 Factors Associated with Disability in Old Age 6
2.3 Previous Studies Related to Physical Disabilities and Chronic Conditions 8
2.3 Trajectories Method 13
Chapter III. Material and Methods 14
3.1 Study Population 14
3.1.1 Taiwan Longitudinal Study on Aging (TLSA) 14
3.1.2 Selected Participants 15
3.2 Measurements 16
3.2.1 Chronic Conditions 16
3.2.2 Duration after Chronic Conditions 17
3.2.3 Physical Disabilities 18
3.2.4 Covariates 19
3.2.5 Statistical Analyses 20
Chapter IV. Results 22
Chapter V. Discussion and Implication 26
5.1 Disability in Different Chronic Condition 27
5.2 Socio-demographic Variables and Disability among Different Chronic Conditions 28
5.3 Health-related Correlates and Disability among Different Chronic Conditions 29
5.5 Practical Implications and Future Directions 33
參考文獻 34

表目錄
Table 1. Sample socio-demographics of adults with and without the selected seven chronic conditions, TLSA 1996 41
Table 2. Raw mean scores and standard deviations of physical disability development of participants with different chronic condition 42
Table 3. Levels and rates of change of physical disability trajectory after diagnosis for each chronic condition 43
Table 4. Estimates of physical disability scores by 5-year interval for each chronic condition based on the fixed effect coefficients 45
Table 5. Random effect comparison between nested models for different chronic conditions 46

圖目錄
Figure 1. Physical disability trajectories after diagnosis for each chronic condition in adult aged over 50 (TLSA 1996-2011) 48
Figure 2. Chronic conditions in Taiwan Longitudinal Study on Aging (TLSA 1996-2011) 49
Figure 3. Strength and mobility activities in Taiwan Longitudinal Study on Aging (TLSA 1996-2011) 50
Figure 4. Instrumental activities of daily living (IADL) in Taiwan Longitudinal Study on Aging (TLSA 1996-2011) 51
Figure 5. Activities of daily living (ADL) in Taiwan Longitudinal Study on Aging (TLSA 1996-2011) 52
Figure 6. Center for Epidemiologic Studies Depression Scale (CES-D) in Taiwan Longitudinal Study on Aging (TLSA 1996-2011) 53
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