社区老人社会支持与医疗利用之相关性研究-以苗栗县为例

【外文题名】Social Support and Health Services Utilization among the Community Elderly in Miaoli, Taiwan

【作者】 毛政贤

【关键词】 情感性社会支持 工具性社会支持 家庭照顾型态 心理健康 医疗利用

【外文关键词】 emotional social support instrumental social support family care type mental health health services utilization

【导师姓名】徐慧娟

【学位名称】硕士

【学位年度】暂无

【学位授予单位】暂无

【所属分类】R395.6,B017,C913.6

【录入时间】2014-11-17

【全文挂接】 读秀挂接

【摘要】 to Size)抽樣720人，由訪員以結構式問卷完訪584人(完訪率81.4%)。並以羅吉斯與卜瓦松迴歸分析，探討影響醫療利用的傾向、需求、能力與社會支持因素。
結果：個案平均年齡74.58±6.17歲，女性佔48.7%，客家籍佔60.9%，教育程度主要為不識字(32.1%)與識字或小學(49.3%)。社會支持方面，工具性支持低的老人在門診利用較高(IRR=1.28)，情感性支持低的老人在住院利用較高(IRR=1.43)；居住的照顧型態方面，相較於固定輪流照顧的老人，無人照顧者在門診與住院利用較高(IRR= 1.96, 1.54)，但急診則較低(IRR=0.15)，而不需他人照顧者在門、急診與住院利用則無差異;女性(IRR=1.48~1.91)、教育程度低(IRR=1.11~1.38)、閩南籍(IRR=1.39~1.89)與外省籍(IRR=1.76~2.14)、罹患一種以上疾病(IRR=1.97~2.88)、日常生活功能障礙(IRR=3.25~5.80)的老人醫療利用普遍較高；認知功能障礙者在門診利用較低(IRR=0.73)，住院則較高(IRR=1.52)。有憂鬱症狀者，在門診(IRR=1.27)與急診(IRR=1.52)利用則有較高現象。
結論：老年人的工具性與情感性支持對醫療利用可能扮演緩衝因子，社會支持在部分醫療利用的影響關係呈現替代模式(substitution model)的關係，但對整體醫療利用的影響仍有限。未來期許強化老年照護政策、社區資源、家人的情感支持與實質照護的投入，以期達到老年人生理、心理與社會的成功老化目標。...

【外文摘要】Objective: This study aimed to investigate the relation between social support and health services utilization among elderly aged at 65 or more, and try to explore the factors affecting utilization with outpatient, emergency and hospitalization service. Methods: Data came from the research project “Successful aging of the elderly in Taiwan (II)” 2004, granted by the National Science Counsil. Six towns in Miaoli County, including the business, mountain and sea regions were selected. Three-stage Stratified Method and PPS (Probability Proportional to Size) was used for sampling. 720 meeting the inclusion criteria and 584 (with completion rate of 81.4%) completed the questionnaire-guided interview. Predisposing, enabling, needs, and social support factors were assumed to affect health service utilization, and the effects were examined by logistic regression and Poisson regression analysis. Results: Of the 584 subjects, 60.9% was Hakka, 48.7% was female. The mean age was 74.58±6.17 years. Most of the subject didn’t have sufficient school education, 32.1% of them reporting illiteracy and another 49.3% receiving school education below six years. Those elderly with low instrumental social support had higher utilization in outpatient service (IRR=1.28). Those with low emotional social support had higher utilization in hospitalization (IRR=1.43). Compared to the elderly having fixed caregiver, those who without any caregiver had higher utilization in outpatient service (IRR=1.96) and hospitalization (IRR=1.54), yet using lower utilization in emergency (IRR=0.15). However, the elderly who perceived no need for care showed no significant difference in services utilization.The elderly who were female (IRR=1.48~1.91), low education level (IRR=1.11~1.38), ethnic groups of FuChien (IRR=1.39~1.89) and Mainland provinces (IRR=1.76~2.14), having one or more diseases (IRR=1.97~2.88), and disabled in activities of daily living (IRR=3.25~5.80), used more medical services. The elderly with cognition function disability used less services in outpatient (IRR=0.73) but more in hospitalization (IRR=1.52). Those with depression symptoms had higher utilization in outpatient (IRR=1.27) and emergency (IRR=1.52). Conclusions: Instrumental and emotional social support of the elderly may play a buffer role in health services utilization. The result supported the “substitutioanl model” for the effect social support in part of health services utilization, but the effect was limited. The policies in elderly care, community resources development, investment of emotional and instrumental social support from the family should be strengthed in the future, in order to achieve the goal of successful aging for the elderly....