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高齡重症病人之衰弱狀態與照護結果之關聯性研究 —以南部某醫學中心為例

2026-08-28T17:33:29Z

標題: 高齡重症病人之衰弱狀態與照護結果之關聯性研究 —以南部某醫學中心為例; Association between Frailty and Care Outcomes in Older Critically Ill Patients: A Study in a Medical Center in Southern Taiwan 作者: 黃煜為; Yu-Wei Huang 摘要: 研究背景與目的：隨著人口老化，入住加護病房 (intensive care unit, ICU) 的高齡病人日益增加。傳統的疾病嚴重度評分系統未必能完全反映高齡病人的生理儲備能力。本研究探討高齡重症病人的衰弱盛行率，並分析衰弱狀態與照護結果及醫療資源後續需求的相關性。研究方法：本研究採回溯性世代研究設計，收集2024年1月至2025年9月期間入住南部某醫學中心ICU之65歲以上病人資料 (N = 1,697)。以臨床衰弱量表 (Clinical Frailty Scale, CFS ) ≥ 5 定義衰弱。統計方法使用多變項線性迴歸及多變項羅吉斯迴歸。研究結果：衰弱盛行率為55.5%。衰弱組院內死亡率高於非衰弱組(25.1% vs. 11.9%, p < 0.001)。控制干擾因子後，衰弱仍與較高院內死亡有關(aOR = 1.67, 95% CI 1.13–2.48, p = 0.010)。衰弱與ICU住院天數 (p = 0.482)及總住院天數 (p = 0.933) 無相關，但存活出院病人中，衰弱者入住機構勝算為非衰弱者之3.13倍 (p < 0.001)。結論：衰弱在台灣高齡重症病人中具高盛行率，不僅會增加院內死亡風險，更會增加出院後對長期照護資源的使用。建議醫院將CFS納入ICU常規篩檢，以利早期啟動分層照護與出院轉銜準備，優化醫療資源配置。; Background and Objectives: As the population ages, the proportion of older patients admitted to the intensive care unit (ICU) continues to rise. Traditional disease severity scoring systems may not fully capture the physiological reserve of older patients. This study aimed to determine the prevalence of frailty among elderly critically ill patients and to examine the associations of frailty status with care outcomes and subsequent healthcare resource needs. Methods: This retrospective cohort study collected data from patients aged 65 years or older admitted to the ICU of a medical center in southern Taiwan between January 2024 and September 2025 (N = 1,697). Frailty was defined as a Clinical Frailty Scale (CFS) score ≥ 5. Statistical analyses included multivariable linear regression and multivariable logistic regression. Results: The prevalence of frailty was 55.5%. In-hospital mortality was significantly higher in the frail group than in the non-frail group (25.1% vs. 11.9%, p < 0.001). After adjustment for potential confounders, frailty remained an independent predictor of in-hospital mortality (adjusted odds ratio [aOR] = 1.67, 95% confidence interval [CI] 1.13–2.48, p = 0.010). In the multivariable model, frailty had no significant independent effect on ICU length of stay (p = 0.482) or total hospital length of stay (p = 0.933). Among patients who survived to discharge, frailty was associated with a 3.13-fold increased risk of institutional care placement (p < 0.001). Conclusions: Frailty is highly prevalent among elderly critically ill patients in Taiwan, independently predicts in-hospital mortality, and serves as a critical early warning indicator for long-term care dependency following discharge. Routine integration of the CFS into ICU admission assessment is recommended to facilitate early risk stratification, care transition planning, and optimal allocation of healthcare resources.

高齡者臨終意象之探討

2026-07-22T10:49:19Z

標題: 高齡者臨終意象之探討; Elder's Image of the End-of-Life 作者: Tzu-Hui Wu; 吳梓卉摘要: 台灣自1993年邁入高齡化社會，十大死因從早年的傳染性疾病轉變為慢性病及癌症，也因此近年來對於安寧療護、預立醫囑等觀念逐漸興起，期望能夠藉此讓人們在面對人生最後一段旅程能夠更有尊嚴，更希望醫療資源能夠得到最妥善之利用。綜觀台灣目前以臨終規劃、善終為主題之研究，大多針對醫護人員或是末期病患及其家屬進行研究，少見以高齡者為研究對象進行研究。本研究以滾雪球法蒐集受訪者進行質性研究，共訪談了34位受訪者，藉以了解高齡者對臨終意象為何？在他們的想像裡怎麼樣才符合心目中的善終？並了解高齡者對近年來興起之議題─安寧療護、安樂死與預立醫囑了解程度與態度。本研究發現如下：一、對於臨終的態度，年紀越大者越不害怕面對，且臨終場所也由過去一定要回到家中嚥下最後一口氣，轉變為醫院或不造成親友負擔之場所皆可，與過去對於臨終之印象有很大的改變。二、受訪者大多已提前向配偶或子女表述臨終時處理之方式，與過往避諱不談此話題有很大的差異。三、與選擇安寧療護之相關因素包含：性別、出生地、職業以及家人死亡經驗；接受安樂死之相關因素包含：性別、臨終場所、宗教以及慢性病；會事先預立醫囑之相關因素則包含：性別、慢性病與教育程度。這些因素間的組合會對於是否選擇該方式有一定程度之影響。

高齡急診病人之衰弱面向與其預後的關聯

2026-07-22T13:37:35Z

標題: 高齡急診病人之衰弱面向與其預後的關聯; Associations Between Frailty Dimensions and Outcomes in Older Emergency Department Patients 作者: 蔡于捷; YU-CHIEH TSAI 摘要: 研究背景和目的老年族群是否衰弱之所以重要，是因為衰弱可做為健康預後的指標。目前全世界對於急診衰弱長者的相關研究其實相對缺乏，而對於老年族群的衰弱議題若不夠警覺，則可能讓因非典型症狀來急診的老年族群有較差的急診品質。透過本研究，我們希望可以了解到使用急診醫療的老年族群中生理、心理、社會衰弱的比率，同時也能了解台灣老年族群急診就診前是否衰弱，對於預後的影響與關聯性。研究方法本研究為前瞻性之觀察性世代研究，針對2022/12/15~2023/03/02至新竹臺大分院生醫醫院竹北院區急診醫學部就診之病患進行收案，資料分析分為探討(1) 急診使用之老年族群是否生理、心理、社會衰弱(2)以及透過多變項羅吉斯迴歸，加入共變項探討生理、心理、社會衰弱，對一個月後追蹤是否再返急診、住院以及死亡有影響。共變項包括年齡、過去病史、一年內跌倒次數、性別、是否為機構住民、是否有多重用藥、當次就醫是否住院等。研究結果研究期間共收案207位民眾，其中有46.38%有生理衰弱，41.06%有心理衰弱， 48.79%有社會衰弱，可發現社會衰弱比率大於生理衰弱再大於心理衰弱。以羅吉斯迴歸分析生理衰弱、心理衰弱、社會衰弱對於一個月預後的影響，發現在調整共變項後，有生理衰弱的長者其一個月內再返急診的風險為沒有生理衰弱的長者的4.43倍(OR=4.43, p<0.01)，有生理衰弱的長者其一個月內再住院的風險為沒有生理衰弱的長者的3.62倍(OR=3.62, p<0.05)，有心理衰弱的長者其一個月內再返急診的風險為沒有心理衰弱的長者的2.23倍(OR=2.23, p<0.05)。另發現社會衰弱有較易一個月住院(OR=2.39, p=0.059)、一個月內死亡(OR=9.00, p=0.052)之傾向。討論本研究之生理衰弱、心理衰弱及社會衰弱比率是比過去研究社區取樣之比率來得高，推論為不同面向衰弱與急診醫療使用的需求有關。此外與過去社區研究不同的是社會衰弱比率高於生理心理衰弱比率，推測可能是因為社會衰弱長者因為社會網絡或支持較薄弱，較有急診醫療需求。以及未來若能針對社區之社會衰弱長者進行介入，或許有機會降低長者急診使用率。本研究發現急診長者生理衰弱及心理衰弱與一個月再返急診之風險有關，前者也與一個月再住院風險有關，而社會衰弱的長者其一個月內再住院及一個月死亡的風險則有較高的傾向。若在急診就診時能篩檢出衰弱，則有機會針對此族群進行介入，像是轉介老年醫學科或是長期照顧管理中心等，可以提升照顧品質，也降低之後的醫療資源的使用。結論本研究是第一個在急診場域同時進行生理、心理、社會衰弱的三面向評估，也點出了急診場域與社區場域之衰弱比率差異，以及衰弱比率與急診一個月預後指標之關聯性，同時也推論社會衰弱與急診醫療使用的關聯性。; Introduction The significance of frailty in the elderly lies in its role as an indicator of health outcomes. Research on the prevalence of frail elderly individuals presenting to the emergency department is lacking worldwide. The aim of this study is to find out the prevalence of frailty among elderly individuals who utilize emergency medical services, and to investigate the relationship between physical, psychological, and social frailties and health outcomes for these elderly individuals in Taiwan. Method This was a prospective observational cohort study that aimed to enroll patients who sought medical attention at the Emergency Medicine Department of National Taiwan University BioMedical Park Hospital Zhubei Branch, from December 15, 2022, to March 2, 2023. The data analysis was divided into two parts: (1) The assessment of physical, psychological, and social frailty among the study participants, and (2) Multivariable logistic regression analysis was conducted to investigate the impact of physical, mental, and social frailty on revisits to the emergency department, readmissions, and mortality within one month of follow-up. Covariates included age, medical history, number of falls within one year, gender, institutional residency, polypharmacy, index admission. Result A total of 207 participants were enrolled. Among them, 46.38% were identified as physical frailty, 41.06% as psychological frailty, and 48.79% as social frailty. Elderly individuals with physical frailty had a 4.43 times higher risk (OR=4.43, p<0.01) of revisit to the emergency department within one month compared to those without physical frailty; and a 3.62 times higher risk (OR=3.62, p<0.05) of readmission within one month compared to the other groups. Elderly individuals with psychological frailty had a 2.23 times higher risk (OR=2.23, p<0.05) of revisit at the emergency department within one month compared to those without psychological frailty. Social frailty was associated with a higher likelihood of readmission (OR=2.39, p=0.059) and mortality (OR=9.00, p=0.052) within one month. Discussion The rates of physical frailty, psychological frailty, and social frailty in this study were higher compared to rates obtained from community samples. This suggests a relationship between different dimensions of frailty and the need for emergency medical care. Furthermore, the rate of social frailty was higher than that of physical frailty, which suggested that older adults experiencing social frailty may have a greater need for emergency medical care due to a lack of social network or support. This higher rate of social frailty compared to psychological frailty highlights the importance of addressing social frailty in interventions targeting social frailty in the community, as it may help reduce the rate of emergency department utilization among older adults in the future. This study found that the risk of revisiting the emergency department within one month among older adults was associated with physiological frailty and physical frailty. Moreover, the risk of readmission within one month was associated with physical frailty. Additionally, older adults experiencing social frailty have a higher tendency towards readmission within one month and higher risk of mortality within one month. Screening frailty during emergency department visits presents an opportunity for intervention and effective reduction of healthcare resources utilization in this population. Conclusion The findings of this study indicated that the prevalence of frailty among elderly individuals in the emergency department wa significantly higher than in the community. Additionally, the presence of physical frailty can assist in predicting the risk of revisit at the emergency department and readmission within one month for elderly patients seeking emergency care. Similarly, the presence of psychological frailty can help assess the risk of revisit at the emergency department within one month for elderly patients seeking emergency care. Most importantly, interventions aimed at reducing frailty in older adults after their discharge from the emergency room are crucial.

高齡人口多重用藥的盛行率與不良健康照護結果的關聯性：多種定義的比較分析

2026-08-31T16:12:55Z

標題: 高齡人口多重用藥的盛行率與不良健康照護結果的關聯性：多種定義的比較分析; Prevalence of Polypharmacy and Its Association with Adverse Health Outcomes in Older Adults: A Comparison of Multiple Definitions 作者: 鍾欣恩; Hsin-En Chung 摘要: 背景　隨高齡人口與多重慢性病患者比例上升，多重用藥已成為全球公共衛生挑戰。然各研究採用的操作型定義不一，限制盛行率與健康結果的跨研究比較。研究目的　比較不同多重用藥定義下的盛行率，分析其與跌倒、急診、住院之關聯，並檢視特定用藥族群的差異。研究方法　使用臺灣全民健康保險資料庫，納入65歲以上病患。研究分別以「全部用藥」及「慢性病用藥」計算藥品種類數，並比較不同觀察期間及ATC第四、第五層分類所得之盛行率。研究另以羅吉斯迴歸分析多重用藥與不良健康照護結果的關聯，並透過回溯式配對病例對照分析檢驗結果穩定性。研究結果　以全部用藥計算時，一年及一個月觀察期間下的多重用藥盛行率分別為86%及48%；以慢性病用藥計算時則為59%及35%。觀察期間縮短時，盛行率明顯下降，ATC分類層級造成的差異較小。各項定義下，多重用藥皆與跌倒、急診及住院顯著相關，次族群與敏感度分析亦呈一致結果。在次族群中，以實際用藥天數界定的慢性用藥族群具有最高盛行率。此外，研究亦發現急性用藥增加也與不良健康結果風險上升相關。結論　時間閾值為影響多重用藥盛行率估計的主要因素，一個月的觀察期較能反映同時用藥狀態。研究建議應建立符合臺灣醫療制度的多重用藥標準定義，納入醫療品質監測，並整合病患完整用藥資訊，以強化高齡用藥風險評估。; Background　As the proportion of older adults with multiple chronic conditions continues to increase, polypharmacy has become a global public health challenge. However, variations in the operational definitions adopted across studies limit the comparability of prevalence estimates and health outcomes. Objectives　This study aimed to compare the prevalence of polypharmacy under different definitions, examine its associations with falls, emergency department visits, and hospitalizations, and assess differences across specific medication-use subgroups. Methods　Data were obtained from Taiwan’s National Health Insurance Research Database, and patients aged 65 years or older were included. The number of medications was calculated using two operational definitions: “all medications” and “chronic disease medications.” Prevalence estimates were compared across different time thresholds and according to the fourth and fifth levels of the ATC classification system. Logistic regression models were used to examine the associations between polypharmacy and adverse healthcare outcomes. A retrospective matched case-control analysis was additionally conducted to assess the robustness of the findings. Results　When all medications were included, the prevalence of polypharmacy was 86% under a one-year time threshold and 48% under a one-month threshold. When only chronic disease medications were included, the corresponding prevalence estimates were 59% and 35%, respectively. Prevalence declined markedly as the time threshold shortened, whereas differences attributable to the ATC classification level were relatively small. Across all definitions, polypharmacy was significantly associated with falls, emergency department visits, and hospitalizations, with consistent findings in subgroups and sensitivity analyses. Among the subgroups, the chronic medication-use group defined on the basis of actual medication-use duration had the highest prevalence of polypharmacy. In addition, a greater number of acute medications was associated with an increased risk of adverse health outcomes. Conclusions　The time threshold was the primary factor influencing estimates of polypharmacy prevalence, and a one-month threshold more accurately reflected concurrent medication use. This study recommends establishing a standardized definition of polypharmacy that is compatible with Taiwan’s healthcare system, incorporating it into healthcare quality monitoring, and integrating information on self-paid medications, over-the-counter medications, Chinese herbal medicines, and actual medication-taking behavior to strengthen medication-related risk assessment among older adults.