心理健康和認知功能障礙與高齡者感染嚴重特殊傳染性肺炎相關初探

Abstract

目的 本研究主要探討心理健康與認知功能障礙對台灣社區高齡者感染嚴重特殊傳染性肺炎(COVID-19)及中重症與死亡的影響。 方法 彰化縣衛生局於108年12月至110年4月，在全縣C據點辦理「高齡者整合式健康檢查(4D健檢)」，篩檢憂鬱、失能、失智、骨密度及衰弱，對象為居住在社區且參與C據點活動的50歲以上長者，共4168人。本研究使用4D健檢進行分析，另追蹤COVID-19感染、中重症及死亡至112年3月底。使用羅吉斯回歸比較人口學變項、PHQ9(5分以上 vs. 0-4分)、AD8(2分以上 vs. 0-1分)，在COVID-19感染、中重症及死亡的風險。 結果 相較於AD8分數0-1分，2分以上的高齡者有較高的COVID-19感染率(30.2% vs. 32.2% )、中重症及死亡率(0.5% vs. 1.2%)，感染COVID-19後也有較高比例中重症及死亡(1.5% vs. 3.8%)。PHQ分數10分以上的COVID-19感染率較低(27.7%)，PHQ9分數0-4分與5-9分的高齡者的COVID-19感染率(30.3% vs. 29.9%)、中重症及死亡率相近(0.5% vs. 0.8%)，但感染COVID-19後，PHQ9分數5-9分比0-4分有較高比例中重症及死亡(1.7% vs. 2.6%)。獨居較非獨居感染COVID-19的調整勝算比為2.1(95%CI: 1.7-2.6)。相比50-59歲，80-89歲中重症及死亡的調整勝算比為4.8(95%CI: 1.1-21.3)，90歲以上為18.5(95%CI: 3.4-102.5)。 結論 心理健康與認知功能障礙與較高的COVID-19中重症及死亡風險相關，應被視為與生理疾病類似的高風險族群，未來面對如同COVID-19新興傳染病可以使用合適的量表如PHQ9與AD8進行感染風險管理。

Objective This study mainly explores the impact of mental health and cognitive impairment on the infection, moderate to severe illness and mortality of COVID-19 among the elderly in Taiwanese communities. Method From December 2010 to April 2010, the Changhua County Health Bureau conducted the "Integrated Health Examination for the Elderly (4D Screening)" in Base C throughout the county to screen for depression, disability, dementia, bone density, and frailty. In this study, 4D screening data was used for analysis, and infection, moderate to severe illness, and mortality of COVID-19 were tracked until the end of March 2011. Logistic regression was used to compare the risks of demographic variables, PHQ9 (5 points vs. 0-4 points), AD8 (2 points vs. 0-1 points) on infection, moderate to severe illness and mortality of COVID-19. Result Compared with AD8 scores of 0-1, elderly people with a score of 2 or above have a higher rate of infection (30.2% vs. 32.2%), moderate to severe illness, and mortality (0.5% vs. 1.2%) of COVID-19, and a higher rate of moderate to severe illness and death after infection of COVID-19 (1.5% vs. 3.8%). The COVID-19 infection rate was lower (27.7%) with a PHQ score of 10 or higher, and the infection rate (30.3% vs. 29.9%), moderate to severe illness, and mortality (0.5% vs. 0.8%) of COVID-19 were similar among elderly people with a PHQ9 score of 0-4 and 5-9 points. However, after infection of COVID-19, PHQ9 scores of 5-9 had a higher proportion of severe illness and mortality than those with PHQ9 scores of 0-4 (1.7% vs. 2.6%). The adjusted odds ratio of living alone for infection of COVID-19 was 2.1 (95%CI: 1.7-2.6) compared with non-living alone. Compared with those aged 50-59, the adjusted odds ratio of severe illness and mortality was 4.8 (95%CI: 1.1-21.3) for those aged 80-89, and 18.5 (95%CI: 3.4-102.5) for those aged over 90. Conclusion Mental health and cognitive impairment are associated with a higher risk of severe illness and mortality of COVID-19, and should be considered as high-risk groups similar to physical diseases. In the future, in the face of emerging infectious diseases like COVID-19, appropriate scales such as PHQ9 and AD8 can be used for infection risk management.