原、漢老人健康需求比較研究

Comparing the Health Needs of Older Aboriginal and Older Ethnic Chinese Individuals in Taiwan

背景：老人健康照護為目前重要國家政策，探討老人健康需求的研究多以都會老人為主，較缺乏針對不同族群老人健康需求之比較研究。原住民與漢人在體質或社會文化發展背景皆有所差異，若能瞭解原、漢老人健康需求，可區隔不同健康照護服務供給，以有效應用健康照護資源，達到不同族群老人所需之健康照護。目的：本研究以全面性老人健康需求評估工具，比較原、漢老人健康需求之差異。方法　採橫斷式研究設計，依比例取樣選取社區65歲以上原、漢老人，以面對面訪談蒐集資料，使用益健社區老人健康需求評估工具於老人家中或社區活動中心進行資料收集。結果　總計收案原、漢老人共計180位，多數原、漢老人有一種以上慢性疾病、失能或虛弱情形。原住民老人在健康需求之不同面向與類別均顯著高於漢族老人。然而，在「居住和財務」、「社會參與及隔離」兩個面向，漢族老人之健康需求較原住民老人為高。迴歸分析發現，「獨立需求」、「衰弱風險」與「跌倒風險」三類別對原、漢老人整體健康需求皆有顯著影響（原住民老人R2 = 64.0%，漢族老人R2 = 69.6%），且三類別對原、漢老人整體健康需求影響有所差異。結論／實務應用　本研究比較原、漢老人健康需求之差異結果發現，原住民老人應從提高其獨立自我照顧能力，漢族老人應考量降低其衰弱風險著手，建議由社區健康服務提供者擬訂介入計畫，提供適合的健康照護服務，以提昇社區老人健康照護成效與品質。

Background: Providing healthcare to older people is an essential policy in Taiwan. Previous studies have assessed the health needs of older people residing in urban areas. Evidence related to the differences in healthcare needs between older aboriginal and older ethnic Chinese people in Taiwan is insufficient. As both groups exhibit mutually distinct physical and socio-cultural attributes, understanding their different health needs is necessary to provide tailored and effective healthcare. Purpose: To investigate the distinct health needs of older aboriginal and older ethnic Chinese using a comprehensive health-needs assessment tool. Methods: A cross-sectional study design was used. Older people aged 65 or over were proportionally sampled from communities. The Elderly Assessment System Care Standard instrument was used to collect data through interviews held in participant homes or in community activity centers between October 20th and December 20th, 2011. Results: A total of 180 older people were recruited. A majority of participants had at least one chronic disease, disability, or frailty. Across a range of dimensions and categories of health needs, older aboriginal people had statistically significant higher health needs than non-aboriginal ones. However, older ethnic Chinese participants had higher levels of need in the domains of housing/financing and social participation/isolation. Regression analysis found that independence, risk of frailty, and risk of falls explained the majority of health needs, with R^2 values of 64% and 69.6% for older aboriginal and older ethnic Chinese participants, respectively. However, the respective impact of these three categories on overall health needs varied between the two groups. Conclusions / Implications for Practice: Based on our findings, healthcare providers should focus on improving the self-care capabilities of older aboriginal people and on reducing the risk of breakdowns in care for older ethnic Chinese people in order to enhance the quality of elderly care in Taiwan.