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系統識別號 U0026-2208201302125900
論文名稱(中文) 中醫門診利用與中老年人身心健康軌跡之相關:8年長期追蹤
論文名稱(英文) Chinese medicine utilization and health related trajectories: An 8-year longitudinal study
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 101
學期 2
出版年 102
研究生(中文) 徐瑜璟
研究生(英文) Yu-Ching Hsu
學號 TC6001065
學位類別 碩士
語文別 英文
論文頁數 66頁
口試委員 指導教授-邱靜如
口試委員-盧豐華
召集委員-楊宜青
中文關鍵字 健康軌跡  認知功能  憂鬱症狀  身體受限  自評健康  中醫門診 
英文關鍵字 health-related trajectory  cognitive functions  depressive symptoms  physical limitation  self-rated health  Chinese medicinal clinic 
學科別分類
中文摘要 背景:中醫門診利用普遍存在於台灣中老年人之醫療利用,但台灣中老年人使用中醫門診的情形,對於生理及心理層面的長期變化為被忽視的議題。本研究的目的為探討有無使用中醫門診者健康軌跡的差異。

方法:使用台灣中老年身心社會生活狀況長期追蹤調查資料,採用1999年問卷中53歲至80歲的中老年人,追蹤八年共三波資料(1999、2003、2007年),總共3659位。採用階層線性模型,控制相關的社會人口學變項及健康相關變項,估計自述有無使用中醫門診的身心健康(認知功能、憂鬱症狀、身體活動度、自評身體健康)隨年齡增加之變化軌跡。

結果:在1999-2007年三波中,至少有使用中醫門診中老人一次的五人中就有一位,但只有4.8%的中老年人在三波中均有使用。在中醫門診使用的健康軌跡,調整影響因素之後,認知功能、憂鬱症狀、活動受限以及自評健康在中老年人有無使用中醫門診隨時間改變的軌跡情形類似。整體來說,使用中醫門診的族群其健康軌跡並沒有隨年齡增加而有惡化的趨勢。儘管在控制性別及共病後,最初使用中醫門診族群的憂鬱以及自評健康均較差,但隨時間的變化並無特別加重的趨勢。而在身體受限及認知功能方面,有無使用中醫門診在最剛開始的分數以及之後的曲線變化沒有統計上的顯著意義。

結論:以目前研究顯示控制性別及共病後,在較憂鬱以及自評健康較差等台灣中老年人較會使用中醫門診的情況,但可能由其他於本研究中未控制的影響因子所解釋,需要臨床人員更注重台灣中老年人尋求中醫門診的原因以及進一步介入的方式,且須較大規模的研究去了解機轉。
英文摘要 Background: There is very limited understanding of longitudinal health impacts in Chinese medicine (CM) users. This study examined health-related trajectories, including cognitive function, depressive symptoms, physical limitations and self-rated health, between CM users and non-users.

Methods: A sample of 3,695 community-dwelling adults, aged 53-80 years, in the 1999 Taiwan Longitudinal Study on Aging (TLSA) were selected in this study and followed up in 2003 and 2007 to investigate their health trajectories. We identified CM users via asking whether subjects had visited clinic of Chinese medicine in the previous year at baseline and each follow-up. Hierarchical linear modeling was used, adjusting for dynamic measurements of socio-demographic and health-related variables.

Results: Twenty to twenty-three percent of the adults reported having used CM in at least one wave during 1999-2007, and only four percent of adults used CM across all waves. Controlled for known social-demographic and health-related covariates, adults using CM were associated with higher depressive symptoms (3.053 vs. 2.074) and poorer self-rated health (2.577 vs. 2.844) at baseline, but their rates of change over time did not differ from their counterpart not using CM. In addition, levels and rates of change in cognitive function and physical limitation were not different in adults with and without using CM.

Conclusions: This is the first study evaluating longitudinal impact of CM on population health while controlling for known demographic and physical factors. CM does not particularly influence the long-term health trajectories of adults as they age. However, the significantly improved model fit suggests CM use as an important role in explaining population health. Future research may be fruitful by investigating factors accounted for higher levels of depressive symptoms and lower self-rated health observed in adults using CM.
論文目次 目錄
中文摘要 II
英文摘要 IV
誌謝 VI
目錄 VII
表目錄 IX
圖目錄 X
主文 1
Chapter I. Introduction 1
1.1 Background 1
1.2 Aim 2
Chapter II. Literature Review 3
2.1 Definition and Utilization of Chinese Medicine (CM) and Complementary and Alternative Medicine (CAM) 3
2.2 Factors Associated With The Use of Chinese medicine (CM) and Complementary and Alternative Medicine (CAM) 5
2.3 Health Impact of Using Chinese medicine (CM) and Complementary and Alternative Medicine (CAM) 7
2.4 Study Topics and Designs of Previous Studies Related to Chinese medicine (CM) and Complementary and Alternative Medicine (CAM) 9
2.5 Health-Related Trajectories in Older Adults 11
Chapter III. Material and Methods 12
3.1 Study population and design 12
3.1.1 Taiwan Longitudinal Study on Aging (TLSA) 12
3.1.2 Selected participants 13
3.2 Measurements 14
3.2.1 The definition of Chinese medicine users 14
3.2.2 Health-related outcome Measures 15
3.2.3 Potential confounding variables 16
3.2.4 Statistical Analyses 17
Chapter IV. Results 18
Chapter V. Discussion and Implication 21
5.1 Prevalence of CM use and factors associated CM users 21
5.2 Different health trajectories of CM users and non-users 22
5.3 Strengths and Limitations 23
Chapter VI. Reference 25
Chapter VII.Submission to journal 44

表目錄
Table 1 Descriptive baseline (1999) characteristics of participants by Chinese medicine clinic utilization status 30
Table 2 Mean and standard deviation of four health-related outcomes in 1999,2003, 2007 by Chinese medicine use statues 32
Table 3 Coefficient estimates of health related trajectory in adults with and without using Chinese medicine 33


圖目錄
Figure 1 Chinese medicine utilization in Taiwan Longitudinal Study on Aging (TLSA) among 1999, 2003 and 2007 35
Figure 2 Cognitive function (m-RAVLT) in Taiwan Longitudinal Study on Aging (TLSA) among 1999, 2003 and 2007 36
Figure 3 Depressive symptoms(CES-D) in Taiwan Longitudinal Study on Aging (TLSA) among 1999, 2003 and 2007 37
Figure 4 Physical limitation in Taiwan Longitudinal Study on Aging (TLSA) among 1999, 2003 and 2007 38
Figure 5 Self-rated health in Taiwan Longitudinal Study on Aging (TLSA) among 1999, 2003 and 2007 39
Figure 6 Chronic diseases in Taiwan Longitudinal Study on Aging (TLSA) among 1999, 2003 and 2007 40
Figure 7 Frame work of health related trajectories in adults with and without using Chinese medicine clinic 41
Figure 8 Age trajectories of cognitive function in adults with and without Chinese medicine (CM) use 42
Figure 9 Age trajectories of depressive symptoms in adults with and without Chinese medicine (CM) use 42
Figure 10 Age trajectories of physical limitation in adults with and without Chinese medicine (CM) use 43
Figure 11 Age trajectories of self-rated health in adults with and without Chinese medicine (CM) use 43
參考文獻 Adams, J., Sibbritt, D., & Young, A. F. (2009). A longitudinal analysis of older Australian women's consultations with complementary and alternative medicine (CAM) practitioners, 1996-2005. [Article]. Age and Ageing, 38(1), 93-99. doi: 10.1093/ageing/afn241
Al Hazzouri, A. Z., Haan, M. N., Galea, S., & Aiello, A. E. (2011). Life-Course Exposure to Early Socioeconomic Environment, Education in Relation to Late-Life Cognitive Function Among Older Mexicans and Mexican Americans. [Article]. Journal of Aging and Health, 23(7), 1027-1049. doi: 10.1177/0898264311421524
Amir Shmueli , I. I., Judith Shuval PhD. (2010). Change and stability: use of complementary and alternative medicine in Israel: 1993, 2000 and 2007. European Journal of Public Health 21(2), 254-259.
Bücker B, G. M., Schoefer Y, Schäfer T. (2008). The use of complementary alternative medicine (CAM) in 1 001 German adults: results of a population-based telephone survey. Gesundheitswesen, 70(8-9), e29-36.
Ben-Shlomo, Y., & Kuh, D. (2002). A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives. [Editorial Material]. International Journal of Epidemiology, 31(2), 285-293. doi: 10.1093/ije/31.2.285
Bucker, B., Groenewold, M., Schoefer, Y., & Schafer, T. (2008). The Use of Complementary Alternative Medicine (CAM) in 1001 German Adults: Results of a Population-Based Telephone Survey. [Article]. Gesundheitswesen, 70(8-9), 559-560. doi: 10.1055/s-2008-1081505
Cartwright, T. (2007). 'Getting on with life': The experiences of older people using complementary health care. [Article]. Social Science & Medicine, 64(8), 1692-1703. doi: 10.1016/j.socscimed.2006.11.034
Chang, L. C., Huang, N., Chou, Y. J., Lee, C. H., Kao, F. Y., & Huang, Y. T. (2008). Utilization patterns of Chinese medicine and Western medicine under the National Health Insurance Program in Taiwan, a population-based study from 1997 to 2003. [Article]. Bmc Health Services Research, 8. doi: 10.1186/1472-6963-8-170
Chen, F.-N., Chao, P.-D. L., Hsieh, C.-L., Lin, C.-C., Chiang, H.-M., Lin, H.-W., . . . Hung, B.-L. (2008). Survey on Adult Behavior and Medication of Chinese and Western Medicine-Based on the Outpatients of a Medical Center in Mid-Taiwan. Journal of Integrated Chinese and Western Medicine 10(2).
Chen FP, C. T., Kung YY, Chen YC, Chou LF, Chen FJ, Hwang SJ. (2007). Use frequency of traditional Chinese medicine in Taiwan. [Article]. Bmc Health Services Research, 7. doi: 10.1186/1472-6963-7-26
Chiu, C. J., & Wray, L. A. (2011). Physical Disability Trajectories in Older Americans With and Without Diabetes: The Role of Age, Gender, Race or ethnicity, and Education. [Article]. Gerontologist, 51(1), 51-+. doi: 10.1093/geront/gnq069
Cohen, R. J., Ek, K., & Pan, C. X. (2002). Complementary and alternative medicine (CAM) use by older adults: A comparison of self-report and physician chart documentation. [Article]. Journals of Gerontology Series a-Biological Sciences and Medical Sciences, 57(4), M223-M227.
Eisenberg, D. M., Davis, R. B., Ettner, S. L., Appel, S., Wilkey, S., van Rompay, M., & Kessler, R. C. (1998). Trends in alternative medicine use in the United States, 1990-1997 - Results of a follow-up national survey. [Article]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 280(18), 1569-1575. doi: 10.1001/jama.280.18.1569
Hsu, M. C., Creedy, D., Moyle, W., Venturato, L., Tsay, S. L., & Ouyang, W. C. (2008). Use of Complementary and Alternative Medicine among adult patients for depression in Taiwan. [Article]. Journal of Affective Disorders, 111(2-3), 360-365. doi: 10.1016/j.jad.2008.03.010
Hsu, M. C., Moyle, W., Creedy, D., Venturato, L., Ouyang, W. C., & Tsay, S. L. (2009). Use of Antidepressants and Complementary and Alternative Medicine Among Outpatients With Depression in Taiwan. [Article]. Archives of Psychiatric Nursing, 23(1), 75-85. doi: 10.1016/j.apnu.2008.03.004
Hung, C.-T., Kuo, T.-A., Lee, J.-L., Chen, W.-Y., Huang, K.-H., & Shih, Y.-W. (2010). 老年人於全民健康保險中醫門診醫療服務之利用分析. 臺灣老人保健學刊 6(2).
Insurance, t. B. o. N. H. (2011). The the total the 100 years Chinese medicine of the the Bureau of National Health Insurance professional medical service quality t. B. o. N. H. Insurance (Ed.)
Joos, S., Musselmann, B., Miksch, A., Rosemann, T., & Szecsenyi, J. (2008). The role of complementary and alternative medicine (CAM) in Germany - A focus group study of GPs. [Article]. Bmc Health Services Research, 8. doi: 10.1186/1472-6963-8-127
Kang, J.-T., Lee, C.-F., Chen, C.-F., & Chou, P. (1995). 單複向求診行爲的相關因素之探討. [The Factors Related to the Patient's Choice of Medical Service-Single Ordual Approach]. 中醫藥雜誌, 6(3), 175-186.
Koo, M., Chang, Y.-Y., Lee, M.-H., Huang, C.-F., Chen, S.-C., & Yeh, Y.-C. (2011). Factors Associated with the Use of Complementaryand Alternative Medicine in Middle-Aged Adultsand Elderly. [中老年人使用輔助療法之相關因子]. Taiwan Geriatrics & Gerontology 6(1).
Lai, M. N., Wang, S. M., Chen, P. C., Chen, Y. Y., & Wang, J. D. (2010). Population-Based Case-Control Study of Chinese Herbal Products Containing Aristolochic Acid and Urinary Tract Cancer Risk. [Article]. Journal of the National Cancer Institute, 102(3), 179-186. doi: 10.1093/jnci/djp467
Lee, A. E. Y., & Chokkanathan, S. (2008). Factor structure of the 10-item CES-D scale among community dwelling older adults in Singapore. [Article]. International Journal of Geriatric Psychiatry, 23(6), 592-597. doi: 10.1002/gps.1944
Lee, C.-H., Chou, Y.-J., Chen, L.-S., & Chang, H.-J. (2004). Utilization of Ambulatory Chinese Medical Services under the National Health Insurance in Taiwan. Taiwan Journal of Public Health, 23(2).
Lee, C. T., Yeh, C. J., Lee, M. C., Lin, H. S., Chen, V. C. H., Hsieh, M. H., . . . Lai, T. J. (2012). Social support and mobility limitation as modifiable predictors of improvement in depressive symptoms in the elderly: Results of a national longitudinal study. [Article]. Archives of Gerontology and Geriatrics, 55(3), 530-538. doi: 10.1016/j.archger.2012.03.002
Lee, K.-L., Ou, Y.-L., Chen, S.-H., & Weng, L.-J. (2009). The Psychometric Properties of a Short Form of the CES-D used in the Taiwan Longitudinal Study on Aging. Formosa Journal of Mental Health, 22(4), 384-410.
Liao, H. L., Ma, T. C., Li, Y. C., Chen, J. T., & Chang, Y. S. (2010). Concurrent Use of Corticosteroids with Licorice-Containing TCM Preparations in Taiwan: A National Health Insurance Database Study. [Article]. Journal of Alternative and Complementary Medicine, 16(5), 539-544. doi: 10.1089/acm.2009.0267
Lin, C.-l., Lin, S.-C., Hsu, F.-L., & Tsai, T.-H. (2005). 中草藥安全性問題探討. Medicine Today (385), 921-926.
Lin YH, C. K., Chiu JH. (2011a). Trends in Chinese medicine use among prostate cancer patients under national health insurance in Taiwan: 1996-2008. Integr Cancer Ther., 10(4).
Lin YH, C. K., Chiu JH. (2011b). Use of Chinese medicine among prostate cancer patients in Taiwan: a retrospective longitudinal cohort study. Int J Urol., 18(5).
Long T. Nguyen, P., MPH, Roger B. Davis, ScD, Ted J. Kaptchuk, and Russell S. Phillips, MD. (2010). Use of Complementary and Alternative Medicine and Self-Rated Health Status: Results from a National Survey. J Gen Intern Med, 26(4), 399-404.
Lou, V. W. Q., Chi, I., Kwan, C. W., & Leung, A. Y. M. (2013). Trajectories of social engagement and depressive symptoms among long-term care facility residents in Hong Kong. [Article]. Age and Ageing, 42(2), 215-222. doi: 10.1093/ageing/afs159
Macfarlane, G. J., El-Metwally, A., De Silva, V., Ernst, E., Dowds, G. L., Moots, R. J., & Arthritis Res, U. K. W. G. C. (2011). Evidence for the efficacy of complementary and alternative medicines in the management of rheumatoid arthritis: a systematic review. [Review]. Rheumatology, 50(9), 1672-1683. doi: 10.1093/rheumatology/ker119
Moss, A. S., Monti, D. A., Amsterdam, J. D., & Newberg, A. B. (2011). Complementary and alternative medicine therapies in mood disorders. [Review]. Expert Review of Neurotherapeutics, 11(7), 1049-1056. doi: 10.1586/ern.11.77
Nagi, & S.Z. (1976). An epidemiology of disability among adults in the United States. Milbank Mem. Fund Q. Health Soc, 54(439–467).
NCCAM. (2008, 2012). What Is Complementary and Alternative Medicine? Retrieved 02-25, 2013, from http://nccam.nih.gov/health/whatiscam
NCCAM. (2012). National Center for Complementary/Alternative Medicine http://nccam.nih.gov/
Ness, J., Sherman, F. T., & Pan, C. X. (1999). Alternative medicine: What the data say about common herbal therapies. [Article]. Geriatrics, 54(10), 33-+.
NHI. (1996). 法律規章 第三章 醫療服務 全民健保.
Nilsson, M., Trehn, G., & Asplund, K. (2001). Use of complementary and alternative medicine remedies in Sweden. A population-based longitudinal study within the northern Sweden MONICA Project. [Article]. Journal of Internal Medicine, 250(3), 225-233. doi: 10.1046/j.1365-2796.2001.00882.x
Olesen, C., Harbig, P., Barat, I., & Damsgaard, E. M. (2013). Absence of 'over-the-counter' medicinal products in on-line prescription records: a risk factor of overlooking interactions in the elderly. [Article]. Pharmacoepidemiology and Drug Safety, 22(2), 145-150. doi: 10.1002/pds.3362
P., C. (2001). Factors related to utilization of traditional Chinese medicine in Taiwan. Zhonghua Yi Xue Za Zhi (Taipei), 64(4), 191-202.
Rabin, L. A., Pare, N., Saykin, A. J., Brown, M. J., Wishart, H. A., Flashman, L. A., & Santulli, R. B. (2009). Differential Memory Test Sensitivity for Diagnosing Amnestic Mild Cognitive Impairment and Predicting Conversion to Alzheimer's Disease. [Article]. Aging Neuropsychology and Cognition, 16(3), 357-376. doi: 10.1080/13825580902825220
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement,, 1, 385-401.
Raudenbush, S., & Bryk, A. (2002). Hierarchical linear models:
applications and data analysis methods. Newbury Park:Sage.
Regidor, E., Pascual, C., Martinez, D., Ortega, P., Astasio, P., & Calle, M. E. (2011). Heterogeneity in the association between socioeconomic position in early life and adult self-rated health in two birth cohorts of Spanish adults. [Article]. Journal of Epidemiology and Community Health, 65(11), 999-1005. doi: 10.1136/jech.2010.110601
Rossler, W., Lauber, C., Angst, J., Haker, H., Gamma, A., Eich, D., . . . Ajdacic-Gross, V. (2007). The use of complementary and alternative medicine in the general population: results from a longitudinal community study. [Article]. Psychological Medicine, 37(1), 73-84. doi: 10.1017/s0033291706008841
Schofield, P., Diggens, J., Charleson, C., Marigliani, R., & Jefford, M. (2010). Effectively discussing complementary and alternative medicine in a conventional oncology setting: Communication recommendations for clinicians. [Review]. Patient Education and Counseling, 79(2), 143-151. doi: 10.1016/j.pec.2009.07.038
Shih, C. C., Su, Y. C., Liao, C. C., & Lin, J. G. (2010). Patterns of medical pluralism among adults: results from the 2001 National Health Interview Survey in Taiwan. [Article]. Bmc Health Services Research, 10. doi: 10.1186/1472-6963-10-191
Shih, S. F., Lew-Ting, C. Y., Chang, H. Y., & Kuo, K. N. (2008). Insurance covered and non-covered complementary and alternative medicine utilisation among adults in Taiwan. [Article]. Social Science and Medicine, 67(7), 1183-1189. doi: 10.1016/j.socscimed.2008.06.011
Sibbritt, D. W., Adams, J., & Young, A. F. (2004). A longitudinal analysis of mid-age women's use of Complementary and Alternative Medicine (CAM) in Australia, 1996-1998. [Article]. Women and Health, 40(4), 41-56. doi: 10.1300/J013v40n04_03
Thomson, P., Jones, J., Evans, J. M., & Leslie, S. J. (2012). Factors influencing the use of complementary and alternative medicine and whether patients inform their primary care physician. [Article]. Complementary Therapies in Medicine, 20(1-2), 45-53. doi: 10.1016/j.ctim.2011.10.001
Tu CC, L. C., Liu CM, Liu CC. (2011). Comparative use of biomedicine and Chinese medicine in Taiwan: using the NHI Research Database. J Altern Complement Med., 17(4), 339-346.
Wang, J. L., Patten, S. B., & Russell, M. L. (2001). Alternative medicine use by individuals with major depression. [Article]. Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie, 46(6), 528-533.
WHO. (2008). Traditional Medicine Retrieved 02-25, 2013, from http://www.who.int/topics/traditional_medicine/en/
Wu, C.-C. (1981). 台灣地區居民社會醫療行為研究. 公共衛生(8), 25-48.
Wu, S. C., Liang, J., Chang, M.-C., Lin, H.-S., & Maloy, N. (1994). Utilization of Health Services among the Elderly in Taiwan. [台灣老人醫療服務之使用]. 中華公共衛生雜誌, 13(2), 168-182.
Zhang, J. X., Woo, J., Lau, W. C. S., Lee, P., Chiu, P., & Lam, D. (2007). Effects of use of alternative therapies on quality of life and healthcare spending. [Article]. American Journal of Chinese Medicine, 35(2), 183-193. doi: 10.1142/s0192415x07004722
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