台灣老人自我照顧行為及其影響因素

Abstract

本研究目的為瞭解台灣老人健康自我照顧情形，包含增進健康自我照顧、疾病預防自我照顧、及整體自我照顧，並進一步探討影響自我照顧的因素。研究資料來自衛生署國民健康局「2003年台灣地區中老年身心社會生活狀況長期追蹤調查」，研究樣本為65歲以上老人，共2,864人。 本研究採用的增進健康自我照顧行為包括規律運動與不抽菸行為，有執行以上行為即各給一分，0-1分表示增進健康自我照顧程度為不好，2分表示增進健康自我照顧程度為好；而疾病預防自我照顧行為包括量血壓、血糖檢查、膽固醇檢查、與健康檢查等，有執行以上行為即各給一分，0-2分表示疾病預防自我照顧程度為不好，3-4分表示疾病預防自我照顧程度為好；整體自我照顧為以上二類自我照顧之整合結果，故其中0-3分表示整體自我照顧程度為不好，4-6分表示整體自我照顧程度為好。 研究結果發現，在增進健康自我照顧方面，67.2%的老人增進健康自我照顧程度為不好，32.8%增進健康自我照顧程度為好；在疾病預防自我照顧方面，44.8 %老人疾病預防自我照顧程度為不好，55.2%疾病預防自我照顧程度為好；綜觀之，老人整體自我照顧程度為不好者佔44.3%，而整體自我照顧程度為好者佔55.7%。利用邏輯斯迴歸分析老人之社會人口學特性、健康狀況、與社會支持等變項對自我照顧的影響。在控制相關影響因子之後，得到重要結果如下：虛弱程度顯著影響自我照顧行為，相較於虛弱者，無虛弱者增進健康自我照顧(男性OR=8.185、女性OR=24.878)、疾病預防自我照顧(OR=1.553)、及整體自我照顧(男性OR=2.333、女性OR=1.837)程度為好之機率皆較高；罹病數目、情緒性社會支持、教育程度亦顯著影響疾病預防自我照顧、及整體自我照顧行為，罹病數目愈多，疾病預防自我照顧(OR=1.395)、整體自我照顧(男性OR=1.408、女性OR=1.533)程度為好之機率皆顯著提高，另相較於低度情緒性社會支持者，具中度、高度情緒性社會支持者疾病預防自我照顧(OR=1.343、1.666)、整體自我照顧(男性OR=1.452、1.685，女性OR=1.540、1.846)程度為好之機率皆較高，而相較於未受正規教育者，初中(職)以上者疾病預防自我照顧(OR=1.483)、整體自我照顧(男性OR=1.917)程度為好之機率亦較高；其他如年齡、居住地區等亦是自我照顧的顯著影響因素。 依據本研究結果，建議在政策上應加強教育程度較低、虛弱、罹病數目少、缺乏情緒性社會支持的老人之健康照護策略，以促進其執行健康自我照顧行為，增進與維持整體健康。

The purpose of this study was to understand self-care behaviors and associated factors among the elderly in Taiwan. Data came from “2003 Survey of Health and Living Status of the Middle Aged and Elderly in Taiwan” , which was conducted by the Bureau of Health Promotion, Department of Health. Our analyses only included subjects aged 65 and over, with a total sample size of 2,864. Promoting self-care behaviors included regular exercise and no smoking. Subjects who performed an activity were assigned a score of one, while those not engaged in that behavior were assigned a score of zero. Scores for the two activites were summed to represent the promoting self-care scale, with a range from zero to two. Preventing self-care behaviors included blood pressure checks, blood sugar screening, cholesterol screening, and periodic physical examination. The same scoring scheme was applied to compose the preventing self-care scale, with a score of two and below as low level of self care, while three and above as high level. Finally, a composite self-care score was determined based on promoting and preventing self-care behaviors scores. A score between zero to three represented poor engagement in overall self-care, and that between four to six as good engagement. The study showed that, among elderly people surveyed, the rates of low-level and high-level promoting self-care behavior were 67.2% and 32.8%, respectively, while the rates for preventing self-care behaviors was 44.8% for the low-level and 55.2% for the high-level. In terms of the overall self-care behaviors, 44.3% were with poor engagement and 55.7% with good engagement. When adjusting for other factors using logistic regression, frailty was the most powerful factor associated with self-care behaviors. Non-frail elderly were more likely to engage in promoting (male:OR=8.185;female:OR=24.878), preventing (OR=1.553), and overall self-care (male:OR=2.333;female:OR=1.837). Other factors, including chronic diseases, emotional social support and education, were also significantly associated with preventing and overall self-care behaviors. Those suffering from more chronic diseases were more likely to engage in preventing (OR=1.395) and overall self-care (male:OR=1.408;female:OR=1.533). Elderly people with more emotional social support had a higher probability of engaging in preventing (OR=1.343,1.666) and overall self-care (male:OR=1.452,1.685; female:OR=1.540,1.846). Lastly, those having junior-high school education and above were also more likely to engage in preventing (OR=1.483) and overll self-care (male:OR=1.917). In addition, factors such as age and region of residence were also significantly related to self-care. According to the findings, elderly who were less educated, frail, having less chronic diseases, and having less emotional social support were less likely to engage in self-care. It is suggested that public policy should provide appropriate self-care interventions designed for this high-risk group.