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題名:服務使用對老人健康之影響-追蹤1994-2000年高雄市三民區社區老人
作者:謝穎慧
作者(外文):Hsieh, Ying-Hui
校院名稱:國立中正大學
系所名稱:社會福利系
指導教授:李美玲
邱亨嘉
學位類別:博士
出版日期:2002
主題關鍵詞:追蹤研究多元功能評估服務使用社會支持
原始連結:連回原系統網址new window
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人口老化問題,突顯老人服務及照顧問題。我國自1994年3月實施全民健保後,老人就醫可近性亦大幅提高,但是,醫療服務的提供對於老人健康的影響性為何?除了醫療服務外,相關的社會照顧又呈現什麼面貌?對於健康有何影響?本文以三個觀察時點的追蹤社區老人資料,並以社會支持理論中的直接保護效果及緩衝效果作為論述服務對健康影響的核心,探討醫療服務中的門診及住院兩項服務,以及四種社會照顧服務-個人照護、家務處理、餐飲準備、以及社會暨娛樂活動,對於老人身體、精神和社會功能的影響。
研究工具主要為中文版老人多元功能問卷,並加入健保門住診費用資料以作為醫療使用的依據。在第一觀察點1994年共計有1,260位社區老人完成訪問,於1998年再追訪成功874位,並於2000年完訪643位,總計在1994-2000追蹤過程中有314位死亡,303位失訪。為了防止失訪者對推論的影響,使用橫斷推算法中的迴歸代入法以及hot deck方法分別估計失訪者的健康狀況以及服務使用情形,並以存活分析法分析影響社區老人死亡之危險因子。
存活分析結果顯示,高齡及男性皆為死亡風險高的人口群,每增加一歲,風險約增加6.1%,而男性死亡風險較女性則增加63%,然而,常看門診對男性老人死亡風險則具有保護效果。此外,IADL分數每增加一分,死亡風險下降約11.7%,顯示IADL對啟動老人的脆弱性具關鍵性,相較於PADL更能預測死亡。而社會功能對老人存活的影響性則反映在自覺孤單程度愈高者,死亡風險增加近50%,表示透過個人知覺所表現的社會整合度對於健康影響的重要性。
服務使用對於健康的效果,會因健康指標不同而有差異。在六項服務類型中,四項社會照顧服務僅社會暨娛樂活動同時具對身體、精神和社會功能等三個面向具正向的保護效果,證實積極參與活動對社區老人的重要性,此亦符合研究假說-即參與社會活動對健康是一種全面性,包含身體、精神以及社會功能,的正面影響。而個人照護、家務處理服務以及餐飲準備等三項服務,作為一種互動關懷性的照顧服務,因內容不同,使其所影響的健康層面亦不同,然對應於有助於緩和身體及精神健康惡化的假說,亦大致符合:其中接受餐飲準備服務者僅在身體健康層面呈現緩衝效果,家務處理服務則在身體及精神層面顯現緩衝效果。此外,全民健保體制下所提供的門診服務對老人身體功能具維持或保護的作用。
關鍵字:追蹤研究、多元功能評估、服務使用、社會支持
Following the growth of aging population, the needs for caring the elderly have emerged as an important issue in the society. In Taiwan, National Health Insurance (NHI) has been implemented since 1994. It has enhanced the availability and accessibility of health care. However, the impact of utilization of services, such as health and social cares, on health has not been evaluated. The major purpose of this study was to evaluate the impact of utilization of services on health based on social support theory, using a community panel data collected from 1994-2000.
The data collection was initiated in 1994. The CMFAQ(Chinese-version Multidimensional Functional Assessment Questionnaire)was used to collect functional status and utilization of service. Additionally, NHI data was retrieved to validate the utilization of health care. A sample of 1,260 elderly resided in community were interviewed in 1994. Among them, 874 completed the second interviewed in 1998. The final number of subjects was 643 who were interviewed in 2000. Between 1994 and 2000, there were 314 deaths and 303 lost to follow-up. Data was imputed using regression and hot-deck methods wherever was suitable.
Results show that age and males had higher risk of dying. Increasing 1 year of age, the risk of dying increased 6.1%. Males were with 63% higher than females in dying But, more outpatient visits were helpful to male elderly. In addition, IADL and social isolation were strong risks of survivorship. The results indicated IADL played an important role on the trigger of frailty. Social integration also significantly influenced the survival of the elderly.
The results of multiple regression analyses of impacts of utilization of services on health varied in different health indicators. Among four types of social service, participation on social activity had protective effect on physical, mental and social functions. This confirmed the importance of participating social activities in free living elderly. Those who received in home cares and meal delivery services, showed the buffering effects on physical and mental health. As to health service, outpatient visits had direct protective effect on physical health. Overall, this study showed health care and social services had positive effects on either physical or mental health of the elderly. Further study on cost-effectiveness will shed light on the priority of the services. Thus, the policy makers can design the services accordingly.
Key words:Panel study, CMFAQ, utilization of services, social support
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