罹患失智症對老人接受居家或機構護理照護結果之影響

Effect of home or institutional health care on health outcomes in older people with dementia

目標：失智者會出現問題行為等徵狀，使其照顧比起一般人困難。國外研究發現失智者與非失智者在照護結果上存在差異，國內目前尚未有全國性研究探討失智者與非失智者在居家或機構護理之照護結果是否存在差異，故本研究目的為探討罹患失智症對居家或機構照護結果之影響。方法：採用回溯性世代研究，研究對象為2008年至2012年間首次使用健保居家照護時已滿65歲以上之新個案，依照護場域進行分層，並使用邏輯斯迴歸納入性別、年齡、共病症程度計算傾向分數後，以1：1方式進行失智組和參考組之配對。追蹤個案於收案日後一年內呼吸道感染、泌尿道感染、壓瘡、骨折及髖部骨折發生情形，並以Stepwise Cox proportional hazardmodel探討失智症與否對居家或機構照護結果之影響。結果：居家照護中失智組呼吸道感染（HR=1.11）、壓瘡（HR=1.43）風險顯著較高。結論：居家照護失智者呼吸道感染及壓瘡風險顯著較高。建議衛生主管機關持續透過機構評鑑增進機構照護結果及提升民眾失智症照護素養，建議服務提供者加強失智症照護技巧、協助轉介長照資源、給予家庭照顧者照顧指導。

Objectives: Patients with dementia exhibit aggressive behavior, which makes it more difficult to care for them. Several studies have shown that there are differences in health outcomes between people with and without dementia; however, in Taiwan there has not been a national population-based study identifying whether or not health outcomes are different between people with and without dementia who receive home and institutional health care. Methods: The study adopted a retrospective cohort study design, and the subjects were elderly who used National Health Insurance Home Health Care for the first time between 2008 and 2012. Patients were stratified by care site and divided into two groups (dementia and non-dementia) using a propensity score with gender, age, and co-morbidity to match subjects. Each case was monitored from the day of entry until a respiratory tract infection, urinary tract infection, pressure ulcer, all fractures, or hip fracture occurred. Stepwise Cox proportional-hazards regression was used to analyze the effect of patients with dementia on health outcomes. Results: The dementia group receiving home health care had a higher risk for respiratory tract infections (AHR=1.11) and pressure ulcers (AHR=1.43) than the non-dementia group. Conclusions: Dementia patients are at a higher risk for respiratory tract infections and pressure ulcers than patients without dementia receiving home health care. Medical institutions should monitor health outcomes in the institutional setting and enhance the skills of family caregivers. Formal caregivers should strengthen the skills of dementia care, pass the long-term care information to patients who need it, and teach family caregivers the skills of caring for dementia patients