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題名：罹患失智症對老人接受居家或機構護理照護結果之影響
書刊名：臺灣公共衛生雜誌
作者：黃敬淳／吳肖琪
作者(外文)：Huang, Ching-chun／Wu, Shiao-chi
出版日期：2017
卷期：36:1
頁次：頁21-31
主題關鍵詞：失智症；照護結果；居家照護；機構照護；Dementia；Health outcome；Home health care；Institutional health care
原始連結：連回原系統網址new window
相關次數：
  • 被引用次數被引用次數:期刊(1) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:1
  • 共同引用共同引用:8
  • 點閱點閱:17
目標：失智者會出現問題行為等徵狀，使其照顧比起一般人困難。國外研究發現失智者與非失智者在照護結果上存在差異，國內目前尚未有全國性研究探討失智者與非失智者在居家或機構護理之照護結果是否存在差異，故本研究目的為探討罹患失智症對居家或機構照護結果之影響。方法：採用回溯性世代研究，研究對象為2008年至2012年間首次使用健保居家照護時已滿65歲以上之新個案，依照護場域進行分層，並使用邏輯斯迴歸納入性別、年齡、共病症程度計算傾向分數後，以1：1方式進行失智組和參考組之配對。追蹤個案於收案日後一年內呼吸道感染、泌尿道感染、壓瘡、骨折及髖部骨折發生情形，並以Stepwise Cox proportional hazardmodel探討失智症與否對居家或機構照護結果之影響。結果：居家照護中失智組呼吸道感染（HR=1.11）、壓瘡（HR=1.43）風險顯著較高。結論：居家照護失智者呼吸道感染及壓瘡風險顯著較高。建議衛生主管機關持續透過機構評鑑增進機構照護結果及提升民眾失智症照護素養，建議服務提供者加強失智症照護技巧、協助轉介長照資源、給予家庭照顧者照顧指導。
Objectives: Patients with dementia exhibit aggressive behavior, which makes it more difficult to care for them. Several studies have shown that there are differences in health outcomes between people with and without dementia; however, in Taiwan there has not been a national population-based study identifying whether or not health outcomes are different between people with and without dementia who receive home and institutional health care. Methods: The study adopted a retrospective cohort study design, and the subjects were elderly who used National Health Insurance Home Health Care for the first time between 2008 and 2012. Patients were stratified by care site and divided into two groups (dementia and non-dementia) using a propensity score with gender, age, and co-morbidity to match subjects. Each case was monitored from the day of entry until a respiratory tract infection, urinary tract infection, pressure ulcer, all fractures, or hip fracture occurred. Stepwise Cox proportional-hazards regression was used to analyze the effect of patients with dementia on health outcomes. Results: The dementia group receiving home health care had a higher risk for respiratory tract infections (AHR=1.11) and pressure ulcers (AHR=1.43) than the non-dementia group. Conclusions: Dementia patients are at a higher risk for respiratory tract infections and pressure ulcers than patients without dementia receiving home health care. Medical institutions should monitor health outcomes in the institutional setting and enhance the skills of family caregivers. Formal caregivers should strengthen the skills of dementia care, pass the long-term care information to patients who need it, and teach family caregivers the skills of caring for dementia patients.
期刊論文
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2.Albrecht, J. S.、McGregor, J. C.、Fromme, E. K.、Bearden, D. T.、Furuno, J. P.(2013)。Nationwide Analysis of Antibiotic Use in Hospice Care in the Final Week of Life。J Pain Symptom Manage，46(4)，483-490。  new window
3.顏慕庸、顏兆熊(20110200)。老人之肺炎。當代醫學，38(2)=448，87-94。  延伸查詢new window
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5.施至遠、陳人豪(20081200)。老年人吞嚥障礙之評估與處置。長期照護雜誌，12(4)，337-346。  延伸查詢new window
6.Hamers, J. P. H.、Gulpers, M. J. M.、Strik, W.(2004)。Use of physical restraints with cognitively impaired nursing home residents。Journal of Advanced Nursing，45(3)，246-251。  new window
7.陳麗華(20130300)。失智症整合照顧。社區發展季刊，141，343-353。new window  延伸查詢new window
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9.Toot, S.、Devine, M.、Akporobaro, A.、Orrell, M.(2013)。Causes of hospital admission for people with dementia: a sys temat ic review and meta-analysis。J Am Med Dir Assoc，14，463-470。  new window
10.Friedman, S. M.、Menzies, I. B.、Bukata, S. V.、Mendelson, D. A.、Kates, S. L.(2010)。Dementia and hip fractures: development of a pathogenic framework for understanding and studying risk。Geriatric Orthopaedic Surgery & Rehabilitation，1(2)，52-62。  new window
11.Jalbert, J. J.、Eaton, C. B.、Miller, S. C.、Lapane, K. L.(2010)。Antipsychotic use and the risk of hip fracture among older adults afflicted with dementia。J Am Med Dir Assoc，11，120-127。  new window
12.黃惠璣、林季宜、王寶英(20070600)。老人或失智老人跌倒危險因子之初探。臺灣老人保健學刊，3(1)，1-13。new window  延伸查詢new window
13.Tolppanen, A. M.、Lavikainen, P.、Soininen, H.、Hartikainen, S.(2013)。Incident hip fractures among community dwelling persons with Alzheimer's disease in a Finnish nationwide register-based cohort。PLoS One，8，e59124。  new window
14.Doupe, M.、Brownell, M.、St. John, P.、Strang, D. G.、Chateau, D.、Dik, N.(2011)。Nursing home adverse events: further insight into highest risk periods。J Am Med Dir Assoc，12，467-474。  new window
15.Magaziner, J.、Zimmerman, S.、Gruber-Baldini, A. L.(2005)。Mortality and adverse health events in newly admitted nursing home residents with and without dementia。J Am Geriatr Soc，53，1858-66。  new window
16.Weller, I.、Schatzker, J.(2004)。Hip fractures and Alzheimer's disease in elderly institutionalized Canadians。Ann Epidemiol，14，319-324。  new window
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19.Huang, S. W.、Lin, J. W.、Liou, T. H.、Lin, H. W.(2015)。Cohort study evaluating the risk of hip fracture among patients with dementia in Taiwan。Int J Geriatr Psychiatry，30，695-701。  new window
20.Wang, H. K.、Hung, C. M.、Lin, S. H.(2014)。Increased risk of hip fractures in patients with dementia-a nationwide population-based study。BMC Neurol，14，175-10。  new window
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22.Tuppin, P.、Kusnik-Joinville, O.、Weill, A.、Ricordeau, P.、Allemand, H.(2009)。Primary health care use and reasons for hospital admissions in dementia patients in France: database study for 2007。Dement Geriatr Cogn Disord，28，225-232。  new window
23.Luk, J. K.、Chan, K. Y.(2014)。Preventing aspiration pneumonia in older people: do we have the ‘know-how'?。Hong Kong Med J，20，421-427。  new window
24.Frytak, J. R.、Henk, H. J.、Zhao, Y.、Bowman, L.、Flynn, J. A.、Nelson, M.(2008)。Health service utilization among Alzheimer's disease patients: evidence from managed care。Alzheimers Dement，4，361-367。  new window
25.Wang, W. W.、Moyie, W.(2005)。Physical restraint use on people with dementia-a review of the literature。Aust J Adv Nurs，22，46-52。  new window
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28.Baker, N. L.、Cook, M. N.、Arrighi, H. M.、Bullock, R.(2011)。Hip fracture risk and subsequent mortality among Alzheimer's disease patients in the United Kingdom。Age Ageing，40，49-54。  new window
29.Wullianallur, R.、Viju, R.(2014)。Big data analytics in healthcare: promise and potential。Health Inf Sci Syst，2，10-1186。  new window
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31.高潔純、林麗嬋(20050900)。從安全概念探討失智者遊走行為的處置。長期照護雜誌，9(3)，223-232。  延伸查詢new window
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研究報告
1.Moïse, P.、Schwarzinger, M.、Um, M.(2004)。Dementia Care in 9 OECD Countries: A Compara-Tive Analysis。Paris：OECD。  new window
學位論文
1.陳欣(2007)。我國失智症盛行率及其病患醫療利用和死亡情形探討(碩士論文)。國立陽明大學。  延伸查詢new window
2.張淑卿(2013)。從實證資料探討失能老人在居家與機構間移轉情形及照護品質(博士論文)。國立陽明大學。  延伸查詢new window
3.許貴英(2014)。機構照顧者被失智症患者攻擊之經驗探討(碩士論文)。國立臺北護理健康大學。  延伸查詢new window
4.宋怡慧(2011)。台灣失智症患者髖關節骨折發生率之研究(碩士論文)。國立成功大學。  延伸查詢new window
圖書
1.Escott-Stump, S.(2008)。Nutrition and Diagnosis-Related Care。Philadelphia：Lippincott Williams & Wilkins。  new window
其他
1.WHO。Dementia，http://www.whoint/mediacentre/factsheets/fs362/en/。  new window
2.Alzheimer's Disease International。About dementia。  new window
3.Alzheimer's Society。The later stages of dementia，https://www.alzheimers.org.uk/。，https://www.alzheimers.org.uk/。  new window
4.Alzheimer's Society。Pressure ulcers (bed sores)，https://www.alzheimers.org.uk/。  new window
 
 
 
 
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