桃園市長者參與健康管理計畫對健康狀態之影響

Abstract

研究背景與目的：我國於2018年成為高齡社會，推估於2026年邁入超高齡社會，人口快速老化，長者活得健康有品質更顯重要。桃園市推動活躍老化仍在萌芽階段，為使長者健康促進方案更有效導入社區，亟需瞭解桃園市政府衛生局於2019年推動「長者健康管理-社區預防及延緩失能服務計畫」，對長者的健康狀態之影響或助益，作為未來政策參考依據。本研究目的，為瞭解社區長者在健康管理課程介入後，對BMI、身心功能及體能上的改變，以及課程參與程度之影響。 研究方法：本研究以65歲以上參與健康管理課程之社區長者為研究對象(n=118)，研究工具為國健署指定的個案評估量表進行前後問卷調查、30秒起坐及睜眼單腳站立前後實測之結果，以分析課程介入前後差異；採準實驗設計，以描述性統計及推論性統計之統計分析方法，探討參與課程的長者之人口學特性，以及在健康管理課程介入後，對於BMI、身心功能分數、30秒起坐次數及睜眼單腳站立秒數之前後差異，並控制性別、年齡、教育程度、居住情形、疾病史及執行醫院等，探討健康管理課程參與程度，對介入成效影響之相關性。 研究結果：本研究樣本以女性居多佔66.10%、平均年齡為71.80歲、教育程度在國高中以上83.90%、與親友同住居佔95.76%、患有慢性疾病佔66.10%、參與12週全勤者佔62.71%。研究結果顯示，睜眼單腳站立相較課程介入前有顯著進步（p <0.001）；30秒起坐相較課程介入前也有顯著進步（p <0.001），且12週全勤參與課程者較未全勤參與者，對於30秒起坐進步呈現顯著正向影響 (p =0.04)。 結論：65歲以上社區長者參與12週健康管理課程後，在表現靜態站姿平衡能力之睜眼單腳站立較介入前有進步，以及表現下肢肌力與肌耐力之30秒起坐相較介入前有進步，並與課程參與程度有正相關。因此，桃園市2019年辦理「長者健康管理-社區預防及延緩失能服務計畫」，對於社區長者在體能表現上確實有助益。建議未來能擴大研究範圍，進一步探討都會型、鄉村型、原鄉部落等之成效差異，並持續追蹤長者健康狀況，可與健保系統比對探討就醫利用情形，以更瞭解合適之健康促進與預防及延緩失能之在地老化高齡政策。

Background and objectives: Taiwan became an aged society in 2018, and is estimated to become a super-aged society in 2026. Considering the rapid population aging, it is more important for the elderly to live healthy and have quality of life. Taoyuan City’s program to promote active aging is still in its infancy. To make the elderly health promotion program more effective in the community, it is vital to access the “Elderly Health Management-Community Prevention and Delayed Disability Service Plan” conducted by Taoyuan City Government in 2019. The effects of the plan will serve as a reference for future policy development. The purpose of this study is to understand the changes of community elders in BMI, physical and mental functions, and physical performance after health management courses; the relationship between those changes and course participation rates is also evaluated. Methods: We studied community elders over 65 years of age who participate in health management courses (n = 118). The research tools were the case assessment scale and physical measurement results specified by the National Health Administration. Through inferential statistics, we discussed the changes of BMI, physical and mental functions, and physical operation in relation with demographic characteristics and the health management course intervention. To further explore the relevance of participation rates and those changes, we compared them while controlling gender, age, education level, living situation, disease history, and execution unit. Results: Women, with the average age of 71.80 years, accounted for 66.10% of the participants; 83.90% had an education level of high school or above; 95.76% lived with relatives and/or friends; and 33.90% suffered from chronic diseases. The results of the study showed that after the course, participants improved significantly in the standing-on-one-foot-with-one-eye-open test ( p <0.001) and the 30-second sit-up test ( p <0.001); participants with full attendance to the 12-week course had significantly better performance in the 30-second sit-up test compared with those without full attendance (p =0.04). Conclusion: After participating in the 12-week health management course, community elders over the age of 65 showed significant improvement in the open-eye one-legged stance that demonstrates static standing balance ability and in the 30-second sit-up test showing lower limb muscle strength and endurance. There is also a strong correlation between significant progress of physical performance and course participation rates. Taoyuan City’s implementation of the “Elderly Health Management-Community Prevention and Delayed Disability Services Program” in 2019 is really helpful for the physical performance of community elders. We plan to expand the scope of research in the future, to further explore the differences of effectiveness in metropolitan areas, rural areas, and native tribes, and to track the health status of the elderly persistently. Additionally, with the help of data from Taiwan’s universal health care system, more appropriate local aging policies can be formed to promote health and prevent disability.