65歲以上老年人急診就醫行為調查－－以某區域教學醫院為例

The Use of Emergency Service in Elderly--An Example for a Regional Teaching Hospital

台灣地區老年人口逐漸增加，老年人常罹患多種慢性疾病並且經常使用急診室的醫療資源。為了了解老人急診醫療使用情形，本研究分析某區域教學醫院民國89年全年急診室所有求診資料，將病患分成65歲以上和65歲以下兩組，比較兩組病患在求醫科別、到達方式、檢傷等級、出院原因等各項指標是否有差異。並且研究各月份老年人求診人數和所佔比例，65歲以上老人男女性常見疾病診斷。結果發現，65歲以上（含）老年人數占全年急診總人數18.96%，就醫科別兩組均以內科為主，但是老年人比非老年人高（80.10% vs 46.52%），檢傷等級在第一、二、三級在統計上都有顯著差異，老年人是以第二級最高，佔40%，非老年人則是第三級最高，佔52.73%，老年人檢傷分類第一級危急程度較非老年人高（22.6% vs 6.99%）。急診就醫後的住院率則是老年人較非老年人高（38.84% vs 11.78%）。老人急診求診最常見的是徵候和診斷未明的各種病態最多，其次是消化道，第三是呼吸道疾患，第四是外傷及中毒。就月份來看老年人急診總人數，以二月份是最高的，其次是三月份。由此可見，醫院的急診部門應就其在醫療照護系統所扮演的角色，針對老年病患的需求做好萬全的準備，使老年人得到更好的緊急醫療照護。

The elderly population is increasing in Taiwan. The elderly often have multiple chronic diseases and frequently use the medical resources of emergency services. To examine the utilization of emergency services in elderly patients, we reviewed all patients admitted to an Emergency Department (ED) of a community teaching hospital from January 1 to December 31, 2000. Patients were divided into two groups; one was over (including) 65 years of age and the other was under 65 years of age. Data comparisons included visiting department, mode of arriving, triage category, and final deposition. The monthly visiting percentage and the common illnesses of the elderly were also analyzed. Of all the emergency patients during the year, 18.96% were the elderly. The main visiting department for the two groups was internal medicine, but the elderly group had a significantly higher percentage (80.10% vs. 46.52%). The two groups had significant differences in triage category 1, 2 and 3. The elderly group was 40% in category 2; the younger group was 52.7% in category 3 and the elderly group had a significantly higher percentage (22.6% vs. 6.99%) in category 1. The elderly group had a significantly higher hospitalized percentage than the younger group (38.84% vs. 11.78%). The leading illnesses in the elderly were unknown diagnosis, gastrointestinal diseases, respiratory diseases, trauma and intoxication. February had the most visiting elderly patients, followed by March. In order to provide better emergency can for the elderly, hospital EDs should be prepared to meet the need of the elderly based on their roles in the medical care system.