臺灣預防及延緩失能照護計畫城鄉參與長者特性和成效差異

Abstract

研究背景與目的：老年人口數快速攀升，伴隨著失能人口數的增加，造成長照和醫療體系之負擔，應從源頭預防及延緩失能，故我國於2016年核定「長照2.0」，強調向前延伸初級預防功能，並於2017年開始積極推動「預防及延緩失能（智）照護計畫」，此計畫課程內容涵蓋運動、營養和認知促進等元素；其服務對象以衰弱老人、輕度失能(智)者及中度失能(智)者為主，提供每期12週，每週1次，每次2小時的介入活動，並於介入前後以Kihon Checklist工具進行前後測，作為成效評估之依據。預防及延緩失能照護計畫之成效已初步被證實，且城鄉的資源、長者特性、健康狀態、健康介入參與者特性等皆有所不同，而國外研究顯示預防及延緩失能之相關健康介入在城鄉上長者特性和參與成效皆有所差異，然國內之相關研究結果並不一致，故本研究之研究目的為探討預防及延緩失能照護計畫的城鄉參與者特性和成效差異。 研究方法：本研究採用次級資料分析進行縱貫式研究，資料來源為衛生福利部國民健康署108年度「長者健康管理－社區預防及延緩失能服務」計畫之長者健康管理平台，共8,562人納入分析，並依提供服務之單位據點地址參照劉介宇等人之分類，將其分為城市組6,448人與鄉村組2,114人。本研究使用卡方檢定和獨立樣本t檢定探討城鄉參與者特性是否有顯著差異，並使用多元線性回歸分析探討控制參與者特性後城鄉參與成效差異，並進一步針對城鄉進行分層分析，探討影響城鄉成效之參與者特性是否有差異。 研究結果：城鄉參與者特性存在差異，城市參與者的教育程度較高（p < .0001***）；鄉村參與者的男性比例較城市高（p < .0001***）、平均年齡較高（p < .0001***）、平均病史診斷總數較多（p < .0001***）、平均病史自覺總數較多（p < .0001***），以及平均BMI較高（p < .0001***）。在控制參與者特性後，鄉村參與者在營養（B = 0.0192，p = 0.0171*）、社交（B = 0.0725，p < .0001***）、憂鬱（B = 0.0858，p = 0.0001***）面向上的成效皆顯著優於城市參與者。此外，在憂鬱面向上，城鄉和SOF有統計上顯著之交互作用（B = 0.0926，p = 0.0166*），意即鄉村中衰弱程度越高者會因為介入在憂鬱成效上受益越多。 結論：預防及延緩失能照護計畫的城鄉參與者特性和成效具有差異，整體而言，鄉村參與者的成效優於城市參與者，且鄉村中衰弱程度高者在憂鬱成效上受益較多，未來仍須研究進一步探討可能之影響因素，例如：城鄉資源差異或出席率差異等。也建議未來政策可針對受益較多之族群優先推廣相關服務，並進行介入內容之調整，使投入之經費可獲得較大之效益。

Background: The rapid growing trend of older adults, along with the increase of disabled, have caused the burden of long-term care and health care system. The Long-term Care 2.0 extends and highlights the importance of disability prevention efforts, which led to promoting policy of the 'Prevention and Delay of Disability Care Plan'. This plan includes several themes, such as healthy diets, exercises, and etc. It targets frail to light disabled older people. Each intervention includes 12 classes, each lasting for 2 hours, over 12 weeks. Before and after the intervention, Kihon Checklist was used to measure the effectiveness of the intervention. The effectiveness of the care plan for preventing and delaying disability has been preliminarily confirmed, and foreign studies have shown that the characteristics of the participants and the effectiveness are different between urban and rural areas. However, past research results were inconsistent. As a result, the purpose of this study is to explore the differences of characteristics and effectiveness between rural and urban older adults who participated in the national-wide health promotion program for community-dwelling older adults in Taiwan. Methods: This is a longitudinal study using secondary data for data analysis. Data were extracted from the information management platform of the 2019 'Elderly Health Management - Health Promotion Program for Community-dwelling Older Adults' project of the Health Promotion Administration, Ministry of Health and Welfare. A total of 8,562 were included in the analysis. Based on the locations of the service providers, participants were divided into the urban group (n=6,448) and the rural group (n=2,114). This study uses chi-square test and independent sample t test to explore whether there are significant differences in the characteristics of urban and rural participants, and uses multiple linear regression analysis to explore the differences of effectiveness between urban and rural after controlling for the characteristics of participants. Furthermore, we also stratified our analysis by urban and rural areas to explore whether there are differences in the participants’ characteristics that affect the effectiveness of the care plan in urban and rural areas. Results: There are differences in the characteristics between urban and rural participants. Urban participants have a higher education level (p < .0001***). Rural participants have a higher proportion of males (p < .0001***), a higher average age (p < .0001***), more medical diagnoses (p < .0001***), more subjective medical history (p < .0001***), and higher BMI (p < .0001***). After controlling for the characteristics of the participants, the rural participants have better effectiveness in nutrition (B = 0.0192, p = 0.0171*), socialization (B = 0.0725, p < .0001***), and depression (B = 0.0858, p = 0.0001***) domains. In addition, there is a statistically significant interaction between urban and rural areas and SOF in the depression domain (B = 0.0926, p = 0.0166*), which meaned that the severer frailty in the rural area, the more benefit may be gained from the intervention in the depression domain. Conclusion: The characteristics and effectiveness are different between rural and urban older adults who participated in the national-wide health promotion program for community-dwelling older adults in Taiwan. Overall, the effectiveness in rural is better than that in urban. In rural, who is more frailty benefits more in the depression domain. However, we still need future research to explore possible related factors, such as the differences in urban and rural resources or differences in attendance rates. In addition to focusing on those who benefit more, we suggested that future policy shall also pay attention to people who don’t benefit from the care plan.