| 摘要: | 台灣，一個現今正處在高齡化社會的國家，高齡者的醫療照護越來越受到重視，雖然關於長期照護機構高齡住民的研究有很多，但對於這些機構住民常見的用藥問題的相關文章卻不多見。本研究之主要目的為呈現台南市長期照護機構中老人多重用藥之盛行率，並探討其相關因素。研究樣本來自5家台南市長期照護機構中共376人，由調查檔中得到樣本之社會人口基本資料、客觀生理及心理健康，生活品質，再連結其健保檔中的門診處方，以取得樣本在研究期間（2012年12月至2014年2月）的用藥資訊。本研究的對象為台南市媽廟，愛心，懷安，慈安和聖公養護中心居住超過3個月以上65歲以上住民，由研究者親自收集資料。研究工具使用結構式問卷，包括：「日常生活評估量表」、「工具性日常生活評估量表」、「認知功能」、「憂鬱狀態量表」、「主要慢性疾病」、「長期給藥治療記錄單」，並且以台灣簡明版世界衛生組織生活品質問卷評估住民生活品質。所得資料以統計軟體SPSS Statistics 21.0進行分析。共收得有效問卷376份。結果顯示，此376人的平均年齡為76.01±8.19歲，均罹患有慢性病，平均罹患有4.11±1.77個慢性疾病，其中86.1%罹患消化系統疾病，78.7%罹患中樞神經疾病，58.5%罹患心臟血壓疾病，57.4%罹患糖尿病。平均每一人吃7.75種藥；日常生活評估量表得分為33.68±5.03；工具日常生活評估量表得分為1.86±1.77；憂鬱狀態簡短量表得分為5.72±3.19；MMSE得分10.78±4.58；各範疇生活品質的得分為：生理19.84±8.33；心理18.13±7.49；社會11.95±4.09；環境29.22±6.26。進一步複回歸分析發現如下：憂鬱狀態 (p=0.002，Ajusted R2=0.935）對用藥種類具有重要的影響?，並且發現其影響是透過年齡的增長使得客觀心理狀態變差造成用藥種類之增加。本論文針對台南市長期照護機構高齡住民用藥之研究，發現多重用藥 (最大單日用藥種數在5種以上) 的盛行率為79.8%，重度多重用藥 (最大單日用藥種數在10種以上) 的盛行率為40.1%。發生多重用藥機會較高者依次為：年齡較高者、無宗教信仰者、教育程度較低者、無子女者、每月收入較低者、未婚者、身體功能狀況之依賴程度較高者、客觀心理健康狀態較差者。 由於長期照護機構都是由機構內照護人員直接將住民之健保卡帶去醫院領藥，因此無固定就醫者較少。如何改進減少多重用藥，進而降低因多重用藥而帶來的風險，是醫療體系制度改革應重視的議題。本研究結果可以了解長期照護中心住民的多重用藥情形之相關影響因子，以作為教學上對高齡者之研究及策畫健保局長期照護計畫的依據，進而亦可做為擬訂衛生政策方向的參考。
Taiwan, a country now in an aging society, health care of the elderly gets more attention, although a lot of studies on the elderly residents in long-term care facilities, but there are few related articles about common drug problem of the residents in these institutions. The main purpose of this study is to show the prevalence of polypharmacy of the elderly in long-term care facilities in Tainan City and explore some related factors. The total number of the study are 376 people, which obtained from a sample survey of the sociodemographic information, objective physical and mental health, quality of life, and then link their outpatient prescription files to get their medication information during the study period (December 2012 to February 2014). The cases of the study were residents from Ma-miao, Ai-xin, Huai-an, Tsz-an, Sheng-gung nursing homes in Tainan City, who lives more than three months and over 65 years old, the researcher collect the information by himself. Research tools using a structural questionnaire, the questionnaire included: " Barthel scale", " Instrumental activities of daily living scale", " Mini-Mental State Examination", " Geriatric Depression Scale," "Major chronic diseases", "Medication records "and " World Health Organization Quality of Life Taiwan version Questionnaire". The data were analyzed by SPSS Statistics 21.0. 376 valid questionnaires were collected. The results show that the average age is 76.01 ± 8.19 years old, and 376 people suffering from chronic diseases, with an average risk of 4.11 ± 1.77 chronic diseases, of which 86.1% suffering from digestive diseases, 78.7% suffering from central nervous system disorders, 58.5% suffering from heart disease, 57.4% suffering from diabetes. Each person takes average 7.75 kinds of medicine in a day, Barthel scale score is 33.68 ± 5.03, Instrumental activities of daily living scale score is 1.86 ± 1.77, Geriatric Depression Scale scores is 5.72 ± 3.19, Mini-Mental State Examination score is 10.78 ± 4.58, each domain score of quality of life: physiological domain is 19.84 ± 8.33, psychological domain is 18.13 ± 7.49, social domain is 11.95 ± 4.09, environment domain is 29.22 ± 6.26. Multiple regression analysis found the depression status (p = 0.002, Adjusted R2 = 0.935) is an important factor that affecting on the medication. Then found the objective mental state deteriorating through the increase of age, then cause an increase of kinds of medication Prevalence of polypharmacy for elderly residents in long-term care facilities in Tainan city (more than five kinds of medication in a single day) was 79.8%, prevalence of severe polypharmacy (more than 10 kinds of medication in a single day) was 40.1%. The higher chance to get polypharmacy is: the higher age, no religion, less educated, childless, lower monthly income, unmarried, higher dependence on physical functional, those with poor objective mental health status. Because long-term care facilities directly brought insurance cards of the resident in order to bring their drugs back, so mostly are fixed medical treatments. How to reduce polypharmacy, thus reducing risk of polypharmacy, is an important health care system issues. The results of this study is to understand medication circumstances of those residents in the long-term care facilities. The results can help the establishment of medication database , and can be used in teaching, research and planning of the NHIs’ long term care program , and thus can be used as formulation reference of health policy direction. |
