有無罹患代謝症候群之老年人對於健康促進生活型態、社會支持與自覺健康狀態之相關性探討

Abstract

背景：代謝症候群可謂是現今文明病，影響中老年人健康甚鉅，對於生理、心理以及社會功能的影響，在近10年的研究深入各族群都有相關的探討，但是較少研究有無罹患代謝症候群的老年人，對於健康促進生活型態、社會支持與自覺健康狀態之間的相關性與差異性為何。 目的：本研究在瞭解有無罹患代謝症候群老年人之健康促進生活型態、社會支持、自覺健康狀態之現況，並探討在人口學特性、疾病特性方面對於三者之差異性及相關性，並找出有無罹患代謝症候群老年人自覺健康狀態之預測因子。 方法：本研究為橫斷式調查研究法，採立意取樣，以結構式問卷與病歷回顧進行調查，研究工具包括：個人基本資料表、疾病相關特性表、社會支持量表、健康促進生活型態量表以及自覺健康狀態量表，於2011年12月1日至2012年3月15日，以臺北市某地區醫院≧65歲，於2010年進行老人健康檢查之無罹患代謝症候群老年人以及同一時期於門診追蹤之罹患代謝症候群老年人為收案來源。 結果：發出220份問卷，收回184位個案資料，184份皆為有效問卷，問卷回收率為83.6%，平均年齡為73.54歲。健康促進生活型態方面，無罹患代謝症候群組的平均得分顯著高於罹患代謝症候群組的平均得分(t = -2.06，p = 0.04)。健康促進生活型態之六個構面，得分最高為「自我實現」層面，得分最低為「運動」層面。自覺健康狀態及社會支持方面，無罹患代謝症候群組與罹患代謝症候群組無顯著差異。已婚者、有工作、教育程度高中以上、近一年無住院者的社會支持、健康促進生活型態與自覺健康狀態得分均顯著較高，健康促進生活型態與「年齡」(r = -0.24，p = 0.00)呈現顯著負相關。單變項羅吉斯迴歸分析發現教育程度(p = 0.00)及健康促進生活型態(p = 0.04)為預測代謝症候群的顯著預測因子，其中教育程度國中以下勝算比為高中以上教育程度的2.21倍(O.R. = 2.21，95% C.I. = 1.24~4.30)，健康促進生活型態勝算比為0.99，表示健康促進生活型態每上升一分，罹患代謝症候群的機率就下降1%。多變項羅吉斯迴歸分析發現性別(p = 0.04)及教育程度(p = 0.00)為顯著預測因子，其中女性勝算比為男性的1.97倍(O.R. = 1.97，95% C.I. =1.01~3.86) ，教育程度國中以下勝算比為教育程度高中以上的2.38倍(O.R.=2.38，95% C.I. = 1.27~4.46)，其它變項在兩次分析中皆無顯著預測力。全部個案在「社會支持」、「健康促進生活型態」及「自覺健康狀態」三者呈現顯著正相關，以「健康促進生活型態」及「婚姻狀況」為自覺健康狀態之顯著預測因子，解釋變異量為7%；無罹患代謝症候群組以「健康促進生活型態」及「教育程度」為自覺健康狀態之顯著預測因子，解釋變異量為15%；罹患代謝症候群組以「婚姻狀況」及「教育程度」為自覺健康狀態之顯著預測因子，可解釋變異量為13%。 結論：針對自覺健康狀態較差的高危險群，包括教育程度低、女性以及未婚之老年人，加強衛生教育宣導以及擬訂相關衛生政策，多數老年人對於運動的認知與執行程度仍較偏低，建議政府單位可以針對老年人規劃促進運動的方案。對於已經罹患代謝症候群的老年人，除了控制疾病避免惡化外，期能透過良好的健康促進生活型態，有效提升病人維護健康的能力。

Background: Metabolic syndrome is a disease of civilization that affects mainly mid-age and elderly people. In the last decade, numerous studies have discussed its impact on the physical, psychological and social functions of various groups of people. However, few studies have probed into the relationship of health promotion lifestyles, social support and perceived health status among elderly people with and without this syndrome. Objective: The purpose of this study is to investigate health promotion lifestyles, social support and perceived health status of elderly people with and without metabolic syndrome. In addition to differences in health promotion lifestyles, social support and perceived health status across demographic and disease variables as well as the correlations between them, this paper also explores predictors of perceived health status for elderly people with and without metabolic syndrome. Method: The method was based on cross-sectional survey and purposive sampling. Data were collected through review of medical records and a structured questionnaire assessing personal information, disease related information, social support, health promotion lifestyle and perceived health status of each respondent. The respondents were selected from people above 65 of age who took a health exam in a regional hospital in Taipei City in 2010 and were diagnosed of not having metabolic syndrome and people above 65 of age who needed to visit the hospital for follow-up assessment or treatment of metabolic syndrome during Dec. 1, 2011~Mar. 15, 2012. Results: Two hundred and twenty questionnaires were distributed, and 184 valid responses were returned, resulting in a response rate of 83.6%. The average age of the respondents was 73.54 years old. In health promotion lifestyle, the group of respondents without metabolic syndrome scored significantly higher than the group of respondents with metabolic syndrome (t=-2.06，p=0.04). Among the six dimensions ofhealth promotion lifestyle, the respondents scored highest on “self-fulfillment” and lowest on “physical exercise”. No significant difference in perceived health status or social support was observed between the two groups. Respondents who were married, on a job, with a senior high or higher education level or who have not been hospitalized over the past year scored significantly higher on social support, health promotion lifestyle and perceived health status. Health promotion lifestyle was significantly and negatively correlated to “age” (r=-0.24，p=0.00). The univariate logistic regression analysis showed education level and health promotion lifestyle (p=0.04) were significant predictors of metabolic syndrome. The odds ratio for respondents with a junior high or lower education level to have metabolic syndrome was 2.21 times of the ratio for those with a senior high or higher education level (O.R.=2.21, 95% C.I.=1.24~4.30). The odds ratio between respondents with and without health promotion lifestyles was 0.99. In other words, with the increase of score on health promotion lifestyle by 1 point, the chances of having metabolic syndrome can be reduced by 1%. Further multivariate logistic regression analysis suggested that gender (p=0.04) and education level (p=0.00) were significant predictors of metabolic syndrome. The odds ratio for female respondents was 1.97 times of the ratio for male ones (O.R.=1.97, 95% C.I.=1.01~3.86), and the odds ratio for respondents with a junior high or lower education level was 2.38 times of the ratio for respondents with a senior high or higher education level (O.R.=2.38, 95% C.I. =1.27~4.46). The other variables were found to have no significant predicting power on metabolic syndrome in the two analyses. “Social support”, “health promotion lifestyle”, and “perceived health status” were significantly and positively correlated among all the respondents. “Health promotion lifestyle” and “marital status” were significant predictors of perceived health status (7% variance explained). For respondents without metabolic syndrome, “health promotion lifestyle” and “education level” were significant predictors of perceived health status (15% variance explained); for respondents with metabolic syndrome, “marital status” and “education level” were significant predictors of perceived health status (13% variance explained). Conclusion: For elderly people with lower perceived health status, including those who were less educated, female and unmarried, more effort should be made to increase health education and set up necessary health policies. As most elderly respondents in this study showed insufficient knowledge and implementation of physical exercise, we suggest government authorities set up more programs to promote physical exercise among elderly people. While seeking medical assistance to combat the syndrome, elderly people with metabolic syndrome should adopt a better health promotion lifestyle to enhance their abilities to maintain their own health and well-being. Keywords: metabolic syndrome, health promotion lifestyle, social support, perceived health status,