住院對中老年人心理健康之影響：以台灣地區中老年人身心社會生活狀況長期追蹤為例

Abstract

我國65 歲以上老年人口自1993年底已占總人口比例的7%，進入由世界衛生組織所定義之「高齡化社會」，如何有效使高齡者生活品質提高，對政府以及產業都是相當重要的議題。而在我國門、住診（包括急診）總醫療花費中，中老年人口占總使用者花費超過七成，即使就醫會對老人生理健康有所改善，但也不可忽略過度使用醫療資源之負面效果，其中一項即是對老人本身造成心理的負面影響。過去研究使用醫療資源對老人心理健康之關係，大多是醫院內部進行心理狀態調查，或是分析憂鬱症狀造成其使用醫療資源使用狀況探討，少有針對整體社會老人樣本，在控制其他變數之下探討其近期住院對於其心理健康之影響，故本研究使用以近期住院與否當作主要變數解釋變數，以憂鬱程度及憂鬱傾向作為心理健康之應變數，觀察並分析模型估計結果。 本研究使用臺灣地區中老年身心社會生活狀況長期追蹤調查（Taiwan Longitudinal Study on Aging)，在控制性別、年齡、經濟狀況等過往文獻中提及會影響憂鬱情形之因子之下進行迴歸分析。第一部份在非平衡資料下，以混合迴歸模型(Pooled Ordinary Least Square Model)及固定效果模型(Fixed Effects Ordinary Least Square Model）進行迴歸分析並觀察估計結果，而第二部分即分群延伸探討男女、中年及老年、是否獨居、不同教育程度及是否有重複住院之不同群體自變數對應變數之效果差異。在兩模型之實證研究結果得出近期住院與否對憂鬱程度及憂鬱傾向皆為顯著正向影響，而在分群探討之部分，男性、中年人、獨居者、國中以上教育程度及重複住院者，其近期住院對其憂鬱程度及憂鬱傾向更為顯著或更大之正向影響。

Taiwan’s population aged 65 and over has accounted for 7% of the total population since 1993, how to effectively improve the quality of life of the elderly has become a very important issue for the government and industry. However, the middle-aged and elderly people account for more than 70% of the total medical expenses (including outpatient, inpatient and emergency). Even if medical treatments can improve the physical health of the elderly, the negative effects of excessive use of medical resources cannot be ignored, one of which is the negative psychological impact on the elderly. In the past, most of the studies on the relationship between the use of medical resources and the mental health of the elderly were conducted in the hospital, or the use of medical resources caused by depression symptoms was analyzed.Therefore,the purpose of this study is to investigate the impact of hospitalization on the mental health of the elderly .The main explanatory variables were depression degree and depression tendency. This study used a longitudinal survey of the physical and mental social life of the middle-aged and old people in Taiwan (Taiwan longitudinal study on Aging). Regression analysis was conducted controlling for determinants of mental health, such as gender, age, economic status, etc., that would affect the depression. In the first part, under the unbalanced data, the Pooled Ordinary Least Square Model and the Fixed Effects Original Lead Square are used. In the second part, we explore the heterogeneous effect by gender,age,living status,education level and number of admissions. The empirical results of the two models show that hospitalization has a significant positive impact on the degree of depression and depression tendency. In the second part, the analysis of heterogeneity shows that the recent hospitalization has a more significant or greater positive impact on the degree of depression and depression tendency of men, middle-aged people, people living alone, education level above junior high school and repeat hospitalization.