男性年老精神病人在長期安置照護下之自然死亡危險因子

Risk Factors for Natural Death in Elderly Psychiatric Male Patients with Long-stay Care

目的：評估男性年老精神病人在長期安置下之自然與可避免死亡率，並找出這群病人之自然死亡的相關危險因子。方法：估計731位接受台灣一家精神專科醫院長期安置之男性年老精神病人在自然與可避免死因的標準死亡比，連結台灣衛生署死亡資料庫確定死因，以嵌入型病例對照研究方法收集108對年紀相符之死亡與存活者在死亡前一年之資料並分析找出晚年之顯著自然死亡相關危險因子。結果：相較於一般民眾，這些病人之自然與可避免死亡風險增加了135%（SMR=2.35,95%CI=1.94-2.85）與221%（SMR=3.21,95%CI=2.36-4.27），死亡者有57位（52.7%）死於可避免死因，多變項分析發現臥床或坐椅狀態、較低身體質量指數、腦血管疾病與較多的慢性身體疾病皆顯著相關於自然死亡，而精神病診斷與抗精神藥物種類皆無顯著相關。結論：長期安置男性老年精神病人仍有較高之自然與可避免死亡率，其自然死亡相關危險風險有較差的行走能力、體重過輕之營養不良、陳舊腦中風與多重慢性身體共病。

Objectives: The aims of the study were to evaluate the natural and avoidable mortality among the elderly male psychiatric patients with long-stay care. We also examined the associated risk factors for natural death in those patients. Methods: We estimated the standardized mortality ratios (SMRs) for natural and avoidable deaths of 731 elderly male psychiatric patients in long-stay care in a psychiatric hospital in Taiwan compared with those in the general population. The causes of death were confi rmed using the digital data of the Department of Health Death Certifi cation System, Taiwan. To identify the late-life risk factors associated with natural death, we used a nested case-control design, and assessed the risk factors during one year before death in 108 decedents and 108 age-matched surviving controls. Results: Compared with those in the general population, the risks of natural and avoidable deaths in the cohort were increased by 135% (SMR = 2.35, 95% confi dence interval = 1.94-2.85) and 221% (SMR = 3.21, 95% CI = 2.36- 4.27), respectively. Fifty-seven of the decedents (52.7%) died of avoidable causes. The results of multivariate analysis showed that natural death was signifi cantly associated with bed/chair-ridden status (p < 0.05), having lower body mass index (p < 0.05), history of cerebrovascular disease (p < 0.05), and increased chronic physical comorbidities (p < 0.05). There were no signifi cant associations with psychiatric diagnosis or type of antipsychotics. Conclusion: The elderly male psychiatric patients under long-stay care had higher natural and avoidable mortality than those in the general populations. The risk factors for natural death in these patients could be related to poorer ambulatory status, under-weight malnutrition, old stroke, and multiple physical comorbidities.