從照顧者觀點解析不健康餘命的啟動與逆襲──以健康決定模型為基礎

Caregivers’Perspectives on the Initiation and Reversal of the Disability-Adjusted Life Years: An Analysis Based on the Health Determinants Model

全球平均餘命從2000年的66.8歲，增加到2019年的73.4歲，這是由於死亡率下降，而不是不健康餘命減少；健康餘命5.4歲的增加，並沒有跟上平均餘命6.6歲的增加（WHO，2025）。本研究目的欲瞭解啟動不健康餘命的因素，開發出延長健康餘命的生活方式，進而提昇生活品質。
研究對象為某國立大學「健康管理」課程64名學生，以半開放式問卷訪問照顧者或家人，關於受照顧者「不健康餘命」共經歷幾年？生活從能自理轉變為無法自理的原因？如果時光倒流，建議如何延後發生生活無法自理？
提供受訪者｢受訪者同意書」、「受訪者授權刊登同意書」，說明研究目的、分析方法及隱私的保護。研究者以「健康決定模型」分析從生活自理變為無法自理的因素，及如何延後其不健康餘命；將資料轉化成概念的編碼，邀請具有質性研究之協同研究者進行編碼之確認。
本研究受照顧者不健康餘命平均為5.8年，不健康餘命啟動包括：生活習慣（跌倒）、遺傳因素（家族病史）、社會因素（居住地遷移）、醫療服務（不適宜的醫療行為）及公共決策（土地拆遷）等；不健康餘命的逆襲包括：生活習慣（健康飲食、運動、戒菸酒）、遺傳因素（家族病史的因應策略）、社會因素（建構無障礙環境）、醫療服務（正確的醫療選擇）及公共決策（提升對於失智症的認知）等。

Globally, life expectancy has increased from 66.8 years in 2000 to 73.4 years in 2019. While healthy life expectancy (HLE) has also increased from 58.3 to 63.7, this was due to declining mortality rather than reduced years lived with disability. In other words, the increase in HLE (5.4 years) has not kept pace with the increase in life expectancy (6.6 years) (WHO, 2025). The aim of this study is to understand the factors that initiate disability-adjusted life years, develop lifestyles that extend healthy life expectancy, and thereby improve quality of life.
The objects are the 64 college students in Taiwan to interview the caregiver of disability process of their elders or relatives. The qualitative research data was collected from the semi-structural questionnaire. The text data are through the systematic classification process of coding and identifying themes by researcher. Co-researcher is coordinated to review and check the concept of data.
The average disability-adjusted life years of the study is 5.8 years. The initiation of the disability-adjusted life years based on determinate health model is included falling(lifestyle), changing of residence (environment), inappropriate medical treatment (health care organization) and family history (human biology). Above all, first, Study results remind to avoid related factors that trigger the disability-adjusted life years. Second, research findings suggest more ways to extend healthy lifespan. Finally, it leads to promote health and well-being based on holistic health perspective.