台灣中老年人慢性期中風患者身心健康之退化狀況

The Decline in Physical and Mental Health among Older Chronic Stroke Patients in Taiwan

10.6288/TJPH2013-32-04-10

王思涵(Szu-Han Wang)；王俊毅(Jiun-Yi Wang)

中老年人 ； 中風 ； 退化 ； 心理健康 ； 身體功能 ； older people ； stroke ； decline ； mental health ； physical functions

台灣公共衛生雜誌

32卷4期（2013 / 08 / 15）

383 - 392

繁體中文

目標：中風是造成老人身心障礙的主因之一。本研究旨在探討台灣中老年中風患者之身心健康退化狀況。方法：擷取「台灣中老年人身心社會生活狀況長期追蹤調查」1999及2003二個年度資料，依二年度中風病史紀錄將個體分為「無中風病史組」（3,207人）、「新發中風個案組」（170人）及「慢性期中風個案組」（109人），分析三組中老年人身心健康狀態。身心健康指標，包括健康自評、基本／工具性日常生活功能、認知困難、憂鬱傾向及生活滿意度等測量。以成對樣本t檢定、Wilcoxon符號化等級檢定及廣義線性方程式分析三組中老年人在二年度間身心健康的退化及其差異。結果：三組中老年人自1999年其後4年的身體健康狀態均明顯退化，「新發中風個案組」身體功能退化尤其明顯；但「慢性期中風個案組」在身心健康六項指標中，有五項的退化幅度與「無中風病史組」無顯著差異。結論：中風是造成患者身心健康狀態改變的重要因素。而慢性期中風患者在多數的身心健康指標之退化並未比無中風者明顯，顯示中風患者在慢性期後身體功能的退化，雖有部分是中風後遺症導致，但老化可能是更大的影響因素。建議慢性期中風患者可透過各種健康促進活動，延遲老化所帶來的衝擊。本研究將中風對患者的影響初步量化，其結果可作為社會政策擬定及照護資源分配的部分參考。

Objectives: Stroke is one of the main causes of physical and mental disability among the elderly. This study investigated the decline in physical and mental health among older stroke patients in Taiwan. Methods: Subjects who completed interviews as part of the Taiwan Longitudinal Study of Aging in both 1999 and 2003 were included. According to their stroke histories, subjects were grouped into three sub-groups: 3,207 never had a stroke, 170 had a stroke between 1999 and 2003, and 109 had a stroke before 1999. Several measures of physical and mental health were analyzed. These included self-rated health status, basic/instrumental activities of daily living, cognitive disability, depression and life satisfaction. Paired-t tests, the Wilcoxon signed-rank test and generalized estimating equations were used to analyze the decline and the differences in physical and mental health of the three groups. Results: After 4 years of followup, all three groups of older people declined in physical health, especially those subjects who had strokes between 1999 and 2003. There was no difference in the decline in physical and mental health between those subjects who had a stroke before 1999 and those who never had a stroke. Conclusions: A stroke could have a significant impact on the physical and mental health of older people; however, on most health indicators, the decline among chronic stroke patients was not significantly different from that of those who never had a stroke. This suggests that the decline in chronic stroke patients is not only a sequel to a stroke but also a result of aging. Chronic stroke patients could participate in health promotion programs to slow down the impact of aging. This study roughly quantified the impact of strokes on older people and could serve as a reference for social welfare planning and the allocation of health care resources.

1. 陳惠真、王香蘋(2005)。台灣老人健康狀況初探1989-1999年。台灣家醫誌，15，25-35。
   連結：
2. WHO. The global burden of disease. Available at: http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_part2.pdf. Accessed October 30, 2012.
3. US Department of Health and Human Services. Healthy People 2020. Available at: http://healthypeople.gov/2020. Accessed October 30, 2012.
4. WHO. Ottawa Charter for Health Promotion. Available at: http://www.who.int/healthpromotion/conferences/previous/ottawa/en. Accessed October 30, 2012.
5. Radloff LS. Name of measure: CES-D Scale. Available at: http://www.columbia.edu/cu/ssw/projects/pmap/docs/gupta_cesdepression.pdf. Accessed October 30, 2012.
6. 行政院衛生署國民健康局：老人健康促進計畫(2009-2012) 。 http://www.bhp.doh.gov.tw/BHPNet/Web/Index/Index.aspx 。引用2012/09/30 。Bureau of Health Promotion, Department of Health, Executive Yuan, R.O.C. (Taiwan). A program about health promotion for elders (2009-2012). Available at: http://www.bhp.doh.gov.tw/BHPNet/Web/Index/Index.aspx. Accessed September 30, 2012. [In Chinese]
7. Pfeiffer E. Short Portable Mental Status Questionnaire (SPMSQ). Available at: http://trans.nih.gov/CEHP/hbpcog-short.htm. Accessed October 30, 2012.
8. 行政院衛生署：衛生統計系列 ( 一 ) 死因統計： 99年度死因統計。 http://www.doh.gov.tw/statistic//EBOOK/2010/2010cod.rar 。引用 2012/09/30 。Department of Health, Executive Yuan, R.O.C. (Taiwan). Health statistical series, part I: statistics of causes of death. Causes of death in 2010. Available at: http://www.doh.gov.tw/statistic//EBOOK/2010/2010cod.rar. Accessed September 30, 2012. [In Chinese]
9. Asakawa, T.,Koyano, W.,Ando, T.,Shibata, H.(2000).Effects of functional decline on quality of life among the Japanese elderly.Int J Aging Hum Dev,50,319-28.
10. Bosworth, H.B.,Horner, R.D.,Edwards, L.J.,Matchar, D.B.(2000).Depression and other determinants of values placed on current health state by stroke patients : evidence from the VA Acute Stroke (VASt) study.Stroke,31,2603-9.
11. Campbell, A.(1976).Subjective measures of well-being.Am Psychol,31,117-24.
12. Carod-Artal, F.J.,Trizotto, D.S.,Coral, L.F.,Moreira, C.M.(2009).Determinants of quality of life in Brazilian stroke survivors.J Neurol Sci,284,63-8.
13. Carod-Artal, J.,Egido, J.A.,González, J.L.,Varela de Seijas, E.V.(2000).Quality of life among stroke survivors evaluated 1 year after stroke: experience of a stroke unit.Stroke,31,2995-3000.
14. Desrosiers, J.,Demer, S.,Robichaud, L.(2008).Short-term changes in and predictors of participation of older adults after stroke following acute care or rehabilitation.Neurorehabil Neural Repair,22,288-97.
15. Evans, D.A.(1990).Estimated prevalence of Alzheimer's disease in the United States.Milbank Q,68,267-89.
16. Gale, C.R.,Sayer, A.A.,Cooper, C.(2011).Factors associated with symptoms of anxiety and depression in five cohorts of community-based older people: the HALCyon (Healthy Ageing across the Life Course) Programme.Psycholo Med,41,2057-73.
17. Hartman-Maeir, A.,Soroker, N.,Ring, H.,Avni, N.,Katz, N.(2007).Activities, participation and satisfaction one-year post stroke.Disabil Rehabil,29,559-66.
18. Hogan, M.(2005).Physical and cognitive activity and exercise for older adults: a review.Int J Aging Hum Dev,60,95-126.
19. Kwok, T.,Lo, R.S.,Wong, E.,Wai-Kwong, T.,Mok, V.,Kai-Sing, W.(2006).Quality of life of stroke survivors: a 1-year follow-up study.Arch Phys Med Rehabil,87,1177-82.
20. Lawton, M.P.,Brody, E.M.(1969).Assessment of older people: self-maintaining and instrumental activities of daily living.Geronotologist,9,179-86.
21. Lee, Y.C.,Chen, Y.M.,Hsueh, I.P.,Wang, Y.H.,Hsieh, C.L.(2010).The impact of stroke: insights from patients in Taiwan.Occup Ther Int,17,152-8.
22. Lemogoum, D.,Degaute, J.P.,Bovet, P.(2005).Stroke prevention, treatment, and rehabilitation in sub-saharan Africa.Am J Prev Med,29,95-101.
23. Mahoney, F.I.,Barthel, D.W.(1965).Functional evaluation: the Barthel Index.Md State Med J,14,56-61.
24. Mayo, N.E.,Wood-Dauphinee, S.,Côté, R.,Durcan, L.,Carlton, J.(2002).Activity, participation, and quality of life 6 months post stroke.Arch Phys Med Rehabil,83,1035-42.
25. Noorbala, A.A.,Bagheri-Yazdi, S.A.,Yasamy, M.T.,Mohammad, K.(2004).Mental health survey of the adult population in Iran.Br J Psychiatry,184,70-3.
26. Norrving, B.(2003).Long-term prognosis after lacunar infarction.Lancet Neurol,2,238-45.
27. Paul, S.L.,Sturm, J.W.,Dewey, H.M.,Donnan, G.A.,Macdonell, A.L.,Thrift, A.G.(2005).Long-term outcome in the North East Melbourne Stroke Incidence Study: predictors of quality of life at 5 years after stroke.Stroke,36,2082-6.
28. Svedberg, P.,Lichtenstein, P.,Pedersen, N.L.(2001).Age and sex differences in genetic and environmental factors for self-rated health: a twin study.J Gerontol B Psychol Sci Soc Sci,56,S171-8.
29. Wu, M.S.,Lan, T.H.,Chen, C.M.,Chiu, H.C.,Lan, T.Y.(2011).Socio-demographic and health-related factors associated with cognitive impairment in the elderly in Taiwan.BMC Public Health,11,22.
30. Yen, Y.I.,Yang, M.J.,Shih, C.H.,Lung, F.W.(2004).Cognitive impairment and associated risk factors among aged community members.Int J Geriatr Psychiatry,19,564-9.
31. 李金和、王俊毅、林怡儒(2012)。慢性腦中風復健門診患者之健康相關生活品質及其相關因素探討。長期照護雜誌，16，143-58。
32. 林昭宏、柴惠敏、廖龍仁、黃昭郎、陳美丁、廖小瑤(2003)。社區居民腦中風患者日常生活活動和生活品質的調查研究。物理治療，28，243-50。
33. 邱弘毅(2008)。腦中風之現況與流行病學特徵。腦中風會訊，15，2-4。
34. 高瓊芳、江慧玲、史麗珠、劉祥仁(2008)。門診中風患者之生活品質及其相關因素探討。實證護理，4，127-37。
35. 程遠揚、周正亮、鄭舜平、劉作仁、詹瑞棋、翁文章(2005)。中老年人中風後憂鬱症之危險因子相關分析。台灣復健醫誌，33，149-59。

1. 吳佩珊(2016)。長照機構腦中風住民休閒活動參與和生活品質之研究。長榮大學護理學系(所)學位論文。2016。1-91。