老人健康折舊與死亡風險：老人整合性照護死亡率之改善

Health Depreciation Factors and Mortality in Older Adults: Improvement of Elderly Intergrated Care Death Rate

10.3966/207321472020031201001

林灼榮(Jwu-Rong Lin)；林建守(Chien-Shou Lin)

健康折舊因子 ； 死亡風險 ； 二元邏輯斯迴歸 ； 老人整合性照護 ； Health Depreciation ； Mortality Risk ； Binary Logistic Regression ； Elderly Intergreated Care

商略學報

12卷1期（2020 / 03 / 01）

1 - 16

繁體中文

台灣的存活曲線自2006年開始逐漸呈現矩形化，也就是目前台灣人口死亡時間多發生在老年時期，而且越到生命後期，存活率下降越明顯；因此，若能找出影響老人死亡關鍵因素，將有助改善老人健康與延長平均餘命。本文以台中榮總高齡醫學中心1248名追蹤資料為例，探討老人健康折舊與死亡之關聯性。在健康折舊因子方面，包含9項區間變數、17項名目變數及4項控制變數，利用兩個獨立母體差異性檢定及二元邏輯斯迴歸等實證方法。主要發現心肌梗塞、血中白蛋白、迷你營養評估及血紅素之增減，對死亡邊際機率，分別為0.072、-0.037、-0.01與-0.009；結果顯示老人死亡風險增加，以心肌梗塞影響效果最大，但血中白蛋白、迷你營養及血紅素增加，可顯著降低老人之死亡風險。綜合以上，針對老人整合性照護體系死亡率的改善，應預防老人心肌梗塞、營養不良、貧血與低白蛋白血症。

Survival curve of Taiwan gradually became rectangularization since 2006. It means that most death of people occurs in the old stage, and the survival rate declines significantly getting toward life end. So researching factors related to elderly death will improve the health and life expectancy. Sample of this study is obtained from the Center for Geriatrics and Gerontology of Taichung Veterans General Hospital including 1248 patients. This study aims at investigating the relationship among health depreciation and mortality. The health depreciation factor includes 9 intervals variables, 17 nominal variables and 4 control variables, and utilize empirical method of two independent populations (death or not), statistical hypothesis test, and binary logistic regression (regression coefficient, odds ratio and marginal probability). To mortality, the marginal probability of myocardial infarction, serum albumin, mini nutrition assessment and hemoglobin are 0.072, -0.037, -0.01 and -0.009. It shows that myocardial infarction most significantly increases mortality risk, but serum albumin, mini nutrition assessment and hemoglobin decrease mortality risk. In conclusion, prevention of myocardial infarction, malnutrition, anemia and hypoalbuminemia will improve mortality of elderly integrated health care system.

1. 王德睦,李大正(2009)。台灣的存活曲線矩型化與壽命延長。人口學刊，38，1-31。
   連結：
2. 衛福部國民健康署中老年身心社會生活狀況長期追蹤調查 ， 2015 ，取自： http//www.hpa.gov.tw/Pages/Dtail.aspx?nodeid=242&pid=1282衛福部國民健康署新聞稿， 2008 ，取自 ：https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1128&pid=1949
3. 衛生福利部統計專區 ， 2017 ， 取自 ：https://dep.mohw.gov.tw/DOS/lp-3541-113.html
4. Alves, Filipa Caeiro,Sun, Jia,Rashid, Abdul,Dai, Lu,Snaedal, Sunna,Ba´ra´ny, Peter,Heimbu¨rger, Olof,Lindholm, Bengt,Stenvinkel, Peter(2018).The higher mortality associated with low serum albumin is dependent on systemic inflammation in end-stage kidney disease.PLoS ONE,13(1),1-15.
5. An, Mi Suk,Kim, Sun A,Lee, Jun-Ho,Choi , Seong-Woo,Shin, Min-Ho(2017).Glycated hemoglobin and all-cause mortality in Korean type 2 diabetes.Chonnam Med J,53,223-228.
6. Ben Zadok, Osnat,Itzha,Kornowski, Ran,Goldenberg, Ilan,Klempfner, Robert,Toledanom, Yoel,Biton, Yitschak,Fisman, Enrique Z.,Tenenbaum, Alexander,Golovchiner, Gregory,Kadmon, Ehud,Omelchenko, Alexander,Barsheshet, Alon(2017).Admission blood glucose and 10-year mortality among patients with or without pre-existing diabetes mellitus hospitalized with heart failure.Cardiovascular Diabetology,16,1-9.
7. Falsetti, Lorenzo,Viticchi, Giovanna,Tarquinio, Nicola,Silvestrini, Mauro,Capeci, William,Catozzo, Vania,Fioranelli, Agnese,Buratti, Laura,Pellegrini, Francesco(2016).Charlson comorbidity index as a predictor of in-hospital death in acute ischemic stroke among very old patients: a single-cohort perspective study.Neurol Science,37,1443-1448.
8. Kang, Hye Ran,Lee, Si Nae,Cho, Yun Ju,Jeon, Jin Seok,Noh, Hyunjin,Han, Dong Cheol,Park, Suyeon,Kwon, Soon Hyo.(2017).A decrease in serum creatinine after ICU admission is associated with increased mortality.PLoS ONE,12(8),1-11.
9. Kengne, Andre Pascal,Czernichow, Sébastien, Hamer, Mark,Batty, G David,Stamatakis, Emmanuel(2012).Anaemia, Haemoglobin Level and Cause-Specific Mortality in People with and without Diabetes.PLoS ONE,7(8),1-8.
10. Kinsela, He W. (2009) An Aging Word: 2008. US Census Bureau, Series P95/9-1. Washington, DC: US Government Printing Office.
11. Kolli, Hari,Rajagopalam, Srin,Patel, Nilang,Ranjan, Rajiv,Venuto, Rocco,Lohr, James,Arora, Pradeep(2010).Mild acute kidney injury is associated with increased mortality after cardiac surgery in patients with eGFR < 60 mL/min/1.73 m2.Renal Failure,32(9),1066-1072.
12. Lee, Seung-Hyun,Kim, Do-Hoon,Park, Joo-Hyun,Kim, Shinhye,Choi, Moonyoung,Kim, Hyonchong,Seul, Da Eun,Soo, Gyeong,Jung, Jin-Hyung,Han, Kyungdo,Park, Young-Gyu(2018).Association between body mass index and mortality in the Korean elderly: A nationwide cohort study.PLoS ONE,13(11),1-12.
13. Lundin, H,Sääf, M,Strender, L-E,Salminen, H A,Salminen, H.(2012).Mini nutritional assessment and 10-year mortality in free-living elderly women: a prospective cohort study with 10-year follow-up.European Journal of Clinical Nutrition,66(9),1050-1053.
14. Osborn, Kilby P IV,Nothelle, Stephanie,Slaven, James E,Montz, Kianna,Hui, Siu,Torke, Alexia M(2017).Cumulative Illness Rating Scale (CIRS) can be Used to Predict Hospital Outcomes in Older Adults.Journal of Geriatric Medicine and Gerontology Volume,3,1-5.
15. Tuvia, Ben,Barsheshet, Alon(2017).Admission blood glucose and 10-year mortality among patients with or without pre-existing diabetes mellitus hospitalized with heart failure.Cardiovascular Diabetology,16,1-9.
16. US Census Bureau(2015).US Census Bureau, (2015) International Data Base..
17. 余豎文(2003)。國立臺灣大學預防醫學研究所。
18. 周玉潔,呂啟圓,李現文(2015)。共病及共病指數研究進展與應用展望。中國公共衛生，31(11)，1513-1516。
19. 國軍退除役官兵輔導委員會，2016。綜合-103 年「榮民亡故」資料統計分析，取自：https://www.vac.gov.tw/cp-2005-2908-1.html
20. 國家發展委員會，2018。中華民國人口推估（2018 至2065 年）。
21. 郭長均(2017)。東海大學國際經營與貿易學系。
22. 陳亮恭,張嘉訓,黃莉蓉(2011)。落實以病人為中心之整合照護：從醫院到基層。台灣醫界，54(6)，26-29。
23. 黃雅慧,林宜芬,陳美如(2017)。營養不良之獨居長者對飲食態度之質性研究－以臺北市某國宅為例。臺灣老年醫學暨老年學雜誌，12(4)，245-256。
24. 楊榮森(2016)。老年人的體重對健康和死亡風險的影響。醫學新知，480，7-8。
25. 謝巧玲(2012)。國立臺北護理健康大學健康事業管理研究所。
26. 謝蔡豪,李俊秀,陳明正,何清幼,余文瑞(2018)。身體質量指數與老年人死亡率之相關性－以實證醫學方法探討肥胖矛盾現象。臺灣老年醫學暨老年學雜誌，13(2)，69-86。