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隨著人口的快速老化與高齡人口的急遽增加對於健康照護系統帶來了巨大的衝擊與壓力。

平均壽命的延長更使得老年慢性病的比率增加,失能需要照護的人口也隨之增加。本研究結 果顯示由1996至2007年台灣老人失能波動情形隨著失能的時間越久,失能的分數亦趨增加,

且Nagi Scale失能分數最高,其次為IADLs失能,最後為ALDs失能。

過去的公共衛生議題較著重於疾病的預防、篩檢、診斷與治療,較少著重於失能的篩檢 與早期發現,以及失能產生後的對應方法,而失能不僅導致失能者身體與心理的衝擊,對於 全民健康保險和全民社會安全體系的財務負擔等社會面問題更是一大隱憂,失能的相關因子 中,年齡、自覺健康狀況、老年症候群數、合併罹病指數CCI是與ADLs、IADLs與Nagi Scale 失能高度相關的危險因子,在失能篩檢中是應該特別關注的項目。性別方面,台灣男性長者 較女性長者在ADLs容易發生失能,相對而言,台灣女性長者較男性長者則在IADLs及Nagi

Scale等較高階的身體活動容易產生失能,因此,在失能篩檢時,男性應較著重於ALDs項目

的衛教與訓練,女性則著重於體能的訓練;教育程度則與IADLs有最高的相關性,顯示教育 程度對於需要認知能力的身體活動功能影響最多,因此,對於教育程度較低的族群應給予較 多的工具性日常活動訓練與衛教;運動行為方面則顯示,則建議老年人每周運動頻率至少要 達到三次以上才能有效延緩IADLs及Nagi Scale等較高階身體活動功能失能的發生。

附件一:2000年台閩地區人口之長期照護概況-按年齡分

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附件二:2010年台閩地區人口之長期照護概況-按年齡分

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附件三:合併罹病指數19類疾病群

罹病診斷類別 Morbidity & Diagnosis Score 心肌梗塞 Myocardial infarction 1 鬱血性心衰竭 Congestive heart disease 1 周邊血管疾病 Peripheral vascular disease 1 腦血管疾病 Cerebral vascular disease 1

失智症 Dementia 1

慢性肺疾病 Chronic lung disease 1 風濕性疾病 Rheumatic disease 1 消化性潰瘍疾病 Peptic ulcer disease 1 輕微肝疾病 Mild liver disease 1

糖尿病 Diabetes without chronic complication 1

半身麻痺(偏癱)或截癱 Hemiplegia or Paraplegia 2

腎臟疾病 Renal disease 2

糖尿病合併慢性併發症 Diabetes with chronic complication 2

任何腫瘤 Any tumor 2

白血病 Leukemia 2

淋巴瘤 Lymphoma 2

中重度肝疾病 Moderate or severe liver disease 3 轉移性疾病 Metastatic disease 6 免疫不全疾病(HIV) Human immunodeficiency virus 6

~ Charlson et al.(1987). Charlson Co-morbidity index 加權指數

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