台灣中老年族群失能率趨勢：以中老年身心社會生活狀況長期追蹤調查重新驗證

Disability trends among middle-aged and older adults in Taiwan: validation using the Taiwanese Longitudinal Study of Aging

目標：隨長者與失能人數上升，長照需求將隨之增加。2010年「國民長期照護需要調查（Long-Term Care Needs of an Aging Population of Taiwan surveys, LTCNAPTS）」長者失能率14.95%，高於行政院人口及住宅普查12.67%，現有失能率推估存在落差，本研究利用「中老年身心社會生活狀況長期追蹤調查(Taiwanese Longitudinal Study of Aging, TLSA)」再估計與驗證失能率及趨勢。方法：分析TLSA 1996、1999、2003、2007、2011年五波資料，「≧50歲、≧65歲」長者「粗失能率」、「加權後失能率」、「以2003/2007/2011年為參考組調整後之失能率」、「依性別及年齡層區分之失能率」，並與兩份資料比較。結果：2007年TLSA失能率落在12.14~18.59%，2011年落在6.50~22.91%，數值較接近LTCNAPTS，失能率逐年增加，女性高於男性，2010-2011年「≧50歲」失能率增幅較「≧65歲」長者高，其餘年份兩族群失能率變化幅度相近。結論：本研究驗證TLSA為有效第三種資料庫，其推估接近LTCNAPTS，失能人數在20年間成長2~4倍。相對國際失能率緩和，台灣面對失能率攀升，未來可採用不同資料來源依失能程度，及使用更精準模型估計長照需求人數，且在中老年族群失能率增幅比長者大，應加強中老年族群失能預防。

Objectives: Population aging and disabilities are associated with long-term care (LTC) needs in Taiwan, but current estimates of disability rates (DRs) are inconsistent. The LTC Needs of an Aging Population of Taiwan survey (LTCNAPTS) reported a DR of 14.95% in 2010, whereas the Taiwan Census estimate was 12.67%. The present study analyzed the Taiwan Longitudinal Study of Aging (TLSA) to verify which survey provides the most accurate DR. Methods: This study used TLSA results from 1996, 1999, 2003, 2007, and 2011 to estimate the DRs and trends among older adults (aged 50 years and older), including the crude, weighted, and adjusted DRs for the reference groups from 2003, 2007, and 2011, stratified by sex and age. Results: The TLSA DRs were 12.14%–18.59% and 16.50%–22.91% in 2007 and 2011, respectively. These rates most closely resemble those of the LTCNAPTS. Women had higher DRs than men, and DRs increased annually. In 2010–2011, DRs among the 50-year-old age bracket increased more drastically than those of the 65-year-old age bracket, and this trend held true for other years as well. The number of Taiwanese older adults with disabilities increased 2–4-fold over the past 20 years, whereas DRs in foreign countries plateaued. Conclusions: This study validates the TLSA as an effective third database and corroborates the DR reported by the LTCNAPTS. New datasets and precise models can be used to predict DRs based on disability levels after LTC 2.0. Preventing disability, especially among the middle-aged population, should be a priority.