老人群體居住安排變動與醫療服務使用之多面向長期研究

A longitudinal study of multi-dimensional interrelationships between changes in living-arrangements and medical service utilization by an older population

目標：老人群體走向「僅與配偶同住」與「獨居」之比例持續上升。過去研究鮮少以動態觀點分析老人居住安排與醫療服務使用情形，因此本研究著眼於填補此知識缺口。方法：本研究以「台灣地區中老年身心社會生活狀況長期追蹤調查」1989～2003年共五波資料為研究資料，運用潛在成長曲線模型探討老人居住安排動態變化對於各醫療服務使用面向之長期風險關聯。結果：透過六種居住安排變動經驗之動態分析角度，研究結果指出累積居住安排內容變動次數越多，僅在住院天數的相對風險變化趨勢有關。居住安排內容轉變為獨居者，雖減少西醫門診與急診使用，但對於住院次數與住院日數的相對風險逐年增加；有配偶之居住內容維繫，則顯著減少住院之長期風險。結論：本文透過國家級長期追蹤資料之實證分析基礎，提出二項核心對比：第一為簡單式與複雜式之居住安排比較，第二則為有無配偶之居住安排比較。掌握此二項核心對比將有助於了解老人居住安排動態變化對於醫療服務使用長期風險的不同影響面貌。

Objectives: It is estimated that the proportion of the elderly population 'who live only as a couple' and 'who live alone' will continue to rise. Studies which focus on the dynamic changes in living arrangements and their temporal association with the use of medical services are few. The aim of this study was to fill this gap in knowledge. Methods: The data were drawn from the 'Survey of Health and Living Status of the Elderly in Taiwan', a population-based, longitudinal study of a nationally representative random sample of adults aged 60 years of age and older. The latent growth curve model was applied to explore the longitudinal development and interrelationships between dynamic changes in living arrangements and medical utilization. Results: The cumulative frequency of changes in living arrangements only increased the risk of additional days of hospitalization. A change in living arrangements to living alone reduced the use of outpatient and emergency services, but increased the relative risk of hospitalization and number of days of hospitalization. Remaining as a couple significantly reduced the risk of long-term hospitalization. Conclusions: This study was distinctive in two ways. First, it compared simple and complex households. Second, it focused on whether people were residing as a couple or not. Future public health strategies must take the impact of dynamic changes in living arrangements on medical service into account.