| 摘要: | 急診使用次數逐年上升，老年人為使用率最高的族群，因為有較高疾病盛行率，而會耗費較多的醫療資源，所以人口老化可能帶來急診壅塞的情形。急診中循環系統問題為老人急診使用者最常見的診斷之一，在慢性病當中高血壓為中老年人盛行率最高的疾病，同時也是心血管疾病的危險因子。本研究將針對高血壓族群探討急診使用的相關因子。
資料來源為國民健康署的台灣地區中老年身心社會生活狀況長期追蹤調查，為一個長期追蹤的世代調查資料。使用 2003 年的調查資料，預測 2007 年是否會使用急診。納入的變相包含疼痛程度、慢性病、一年內是否使用過急診、身體功能、認知功能、憂鬱、社會支持、年齡、性別、種族、教育程度、婚姻狀況、收入、居住地區。雙變項分析使用卡方檢定及 student t-test，多變項分析則使用羅吉斯回歸。
研究結果指出疼痛程度越嚴重的人越容易使用急診，疼痛程度中度
(OR=1.393)、嚴重程度的人(OR=2.060)。在糖尿病(OR=1.411)以及心臟病的人(OR=1.533)較容易使用急診，有 IADL 失能一項以上的人較容易使用急診(OR=1.498)。社會支持(採連續型)越好的人，會降低使用急診的機會(OR=0.946)。
疾病的特性可能為老人使用急診的主因，而身體功能的限制可能不利於疾病的照顧。高血壓的疾病照護需求，須配合醫囑服藥及生活習慣的調整，社會支持可能有利於其疾病照顧。且未來應更重是老人的疼痛問題，可能為代表疾病嚴重程度或可能有其他併發症，應盡速就醫找到病因，給予適當的處置及控制疼痛。
Background: Hypertension is the highest in the elderly chronic diseases, and Hypertension is an important risk factor of lead the emergency department uses.
Purpose: To investigate the determinants of emergency room (ER) utilization among Hypertension Taiwanese over 50 years old.
Methods: Data for this research come from 2003 and 2007 of the Survey of Health and Living Status of the Elderly, including 1335 people aged over 50. 2003 survey data were used to examine the effects of the 2007 emergency department use. Social-economic status , demographic characteristics, health behavior, use of the medical service, physical health status, mental health status, social support were used as predictors. Logistic regression were used to assess whether the factors could
predict emergency department utilization.
Results: There were 22.7% cases use the emergency department in 2007. After controlling for other predisposing, enabling, need factors, and healthcare services use with multivariate logistic regression model, the people who have more severely chronic pain were more likely to use emergency department (OR =1.393, 95%CI
=1.012-1.919, OR= 2.060, 95%CI= 1.241, 3.421), having chronic diseases were more likely to go to the emergency department (Diabetes mellitus OR= 1.411, 95% CI=1.025 - 1.942, heart disease OR =1.533, 95%CI=1.139 - 2.063). The people who visited emergency department more often were found to have IADL disable (OR = 1.498, 95%CI = 1.018 - 2.204), and less social support (OR = 0.946, 95%CI=0.894 - 0.989).
Conclusions: The elderly people who have chronic pain, Diabetes mellitus and heart disease were more likely to go to the emergency department. Disabled and the people
who have less social support may make the disease hard to control, as a result they were more likely to go to the emergency department. |
