都市與鄉村社區老人健康狀態

Health Status of Elders in Urban and Rural Communities

本研究以隨機及集束抽樣方式選取台北縣都市型社區新莊市及鄉村型社區萬里鄉六十五歲以上老人共507人（新莊市395位、萬里鄉112位）為研究對象。以健康檢查及問卷搜集資料。健康檢查包括身體理學檢查、血球計數、血液生化檢查、尿液檢查、心電圖、胸部及腹部放射線檢查。問卷內容包括人口學變項、主要慢性疾病史、長期用藥、醫療資源運用狀況、日常生活功能評估、心智功能、情緒狀況、家庭相處情況、社會資源、以及個人健康行為如運動、抽煙、飲酒等。由醫師及受訓之訪員做身體檢查及訪問。配合全民健保老年人預防保健服務，進行詳細健康檢查及老人健康需求與自我照顧的問卷評估。共有507位老人完成完整的健康檢查與問卷調查。萬里鄉老人自訴無慢性病比率較新莊市多（36.6% vs. 25.4%），但未達統計學有意義差距。慢性病病史前五名為高血壓、心血管疾病、糖尿病、消化性潰瘍及牙周病；兩社區只有排序略有不同。新莊市的肺病史較多、萬里鄉的牙周病較多。健康檢查結果僅10%的老人完全正常；健康問題以高膽固醇血症（52.5%）、高血壓（41.0%）、齲齒（26.1%）、腎功能異常（25.3%）、貧血（24.6%）、肝功能異常（16.4%）、糖尿病（10.1%）及牙周病（19.1%）為多。牙周病、齲齒、高血壓、腎功能異常、心臟聽診異常、腹部檢查異常、直腸肛門檢查異常比率以新莊市為多, 貧血與球蛋白異常以萬里鄉為多。胸部X光異常比率沒有差別，心電圖異常比率以新莊市為高，腹部X光異常比率（主要為腰椎病變）以萬里鄉為高。心智功能以新莊市老人較佳，其中男性又高於女性。兩地老人的日常生活功能則並無差異。新莊市老人有較多健康行為及較少不健康行為。但都市老人較常跌倒，服藥比率也較高。鄉村與都市老人的健康好壞有明顯的差異，亦各有其獨特的健康問題。部分原因可能與生活環境與方式的不同有關，不過仍需進一步研究求證。都市與鄉村老人健康的需求上有所不同，在提供醫療照顧時必須考慮城鄉的差異，以提供更適切的服務。

Taiwan became an aged society since 1993. As more people lived older and longer, the health care of aging people will be an important issue for the society. According to previous studies in Western countries and some Asian countries, the health status and needs are different for elderly people living in urban and in rural community. It is important to understand those differences before the planning and implementation of elderly health care. A random cluster sample of 507 elderly persons was selected and surveyed. Of them, 395 elderly people (262 male and 133 female) were from an urban community and 112 (59 male and 53 female) were from a rural community in Taipei County. Data were collected by questionnaires and health examination including a complete physical examination, blood test, chest and abdomen X-ray, and a 12-lead EKG. Past medical history, healthy and unhealthy habits, mental function, activity of daily living, anxiety and depression symptoms, social and family support were assessed by questionnaires. The results revealed that elders living in rural community seemed to be healthier than elders living in urban community. Urban elders had more chronic medical diseases including pulmonary and dental problems, higher percentage of abnormal serum creatinine level, and more fall history. Rural elders had more unhealthy habits, anemia and poor mental function. Both groups had no difference in function of daily activities, and anxiety and depression symptomatology. Rural elders also reported less social and positive family supports but not negative family support. Differences in health status do existed between elders living in rural and urban community. However, how locale affects health status in elderly people needed further study.