There was fairly average and no significant difference in the gender of the participants, with female a little bit more (51.1%) than male (48.9%). The aborigine, by another hand, made up for 1.4% of total recruitments.
The mean age of the participants were 74.4 (±6.9) years old, range between 55 years old and 106 years old. Most of them were younger old age between 65 and 74, counted for 54.3%. The middle old, age 75 to 84, constituted of 36% of the total participants. Those age below 65 and above 85, were minority with only 0.6% and 9.1% of total enrollment respectively.
In this study, over 70% of the enrollees were illiterate (24.3%) or received only elementary school education (47.5%). Participants received higher education counted for 28.2% only, with 12.9% were junior high school educated, 9.9% were high school educated. The highly educated population, was uncommon among those elder
generation, with only 5.4% of them had attended to college or university.
The details showed below (Table 4.2).
37
Table 4.2 General demographic status of the enrollees (n=40,140)
Frequency Percentage (%) Genders
Female Male
20,514 19,626
51.1 48.9 Aborigine
Yes No
555 39,585
1.4 98.6 Age
65 below 65~74 75~84 85 & above
228 21,798 14,448 3,666
0.6 54.3 36.0 9.1 Education
Illiterate
Elementary school Junior high school High school College and above
9,749 19,053 5,179 3,974 2,185
24.3 47.5 12.9 9.9 5.4
II. Bivariate Analysis of MCI and Demographic Status
When looked further into the bivariate analysis, the study was found no significant difference in regard of gender between those MCI positively and
negatively screened cases. However, they did have significant differences in regard of ethnicity, age, and educational levels (Table 4.3).
A large part of suspected MCI cases were age 80 and above (41.6%), while the third age quartile, those age 73 to 79, were among second higher (28.3%). The community dwellers age below 72 had relatively lower proportion of being mild cognitive impairment suspicion.
There were 79.4% of suspected MCI cases received only education lower than elementary school , 37.8% of them were illiterate and 41.6% of them were elementary school educated, four time higher than those attended to junior high school (10%), high school (7.1%), or college and university (3.5%).
38
Table 4.3 Comparison of differences of suspected MCI cases according general demographic status(n=40,140)
MCI
Value p a Positive (%)
(n=579)
Negative (%) (n=39,561) Genders
Female Male
305(52.7) 274(47.3)
20,209(51.1) 19,352(48.9)
0.580 0.446
Aborigine
Yes No
34(5.9) 545(94.1)
521(1.3) 39,040(98.7)
86.840 0.000
Age
68 & below 69~72 73~79 80 & above
93(16.1) 81(14.0) 164(28.3) 241(41.6)
11,804(29.8) 8,310(21.0) 10,791(27.3) 241(21.9)
150.558 0.000
Educational
levels Illiterate
Elementary school Junior high school High school College and above
219(37.8) 241(41.6) 58(10.0) 41(7.1) 20(3.5)
9,530(24.1) 18,812(47.6) 5,121(12.9) 3,933(9.9) 2,165(5.5)
61.323 0.000
Enrollment
patterns Community
Primary health centers Hospital settings Others
344(59.4) 160(27.6) 45(7.8) 30(5.2)
24,224(61.2) 11,839(29.9) 2,945(7.4) 553(1.4)
57.637 0.000
a Based on χ2 test for the difference in examined categorical variables of participants with MCI positive and MCI negative
39
III. Risk Factors Analysis of MCI
Through logistic regression analysis, this study found that the MCI suspicion was associated with ethnicity, age, and educational level.
It was found that the aborigine was 5.727 (95% CI: 3.978 - 8.245) timehigher risk than non-aborigine to be more susceptible to MCI. Along with the increasing age, the suspicion of MCI elevated. Those age over 73 were 1.842 (95% CI: 1.416 - 2.397) time higher risk of MCI suspicion than those age below 68, while the population age over 80 was 3.616 (95% CI: 2.802 - 4.688) time higher. The educational level, by the other hand, was a protecting factor to MCI as the suspicion of MCI decreased when higher education received.
The details were showed as Table 4.4.
Table 4.4 Predictors of MCI: results from logistic regression analysis
OR 95% CI p Value
Genders
Female Male
1
0.846 0.706 1.013 0.068 Aborigine
No Yes
1
5.727 3.978 8.245 0.000 Age
68 & below 69~72 73~79 80 & above
1 1.232 1.842 3.616
0.910 1.416 2.802
1.667 2.397 4.688
0.177 0.000 0.000 Educational levels
Illiterate
Elementary school Junior high school High school College and above
1 0.682 0.613 0.582 0.515
0.562 0.454 0.411 0.321
0.827 0.829 0.826 0.825
0.000 0.001 0.002 0.006
40
Section 3 The Kaigo Yobo Checklist (介護予防チェックリスト)
Screening
The Kaigo Yobo checklist (介護予防チェックリスト), as a supplemental screening, was supposed to be performed along with the AD-8 screening during the Routine Health Check-up for Elderly within the year. However, due to the deferral, the Kaigo Yobo checklist was carried out during the second wave of the check-up and was only able to enroll 19,164 cases eventually. Despite being used as a supplement to the AD-8 screening, the Kaigo Yobo checklist did include more information on demographic status and probable future long-term care needs
I. The Socio-demographic Status
The Table 4.5 summarized the socio-demographic status obtained through the Kaigo Yobo checklist.
The distributions on gender, age, aborigine, and education level for those enrollees who completed Kaigo Yobo checklist were highly similar to total
recruitment. The woman constituted 50.9% of Kaigo Yobo checklist recruitment and man 49.1% while the aborigine made up 0.9% of enrollment. The mean age was 74.4(±6.79) ranged from 55 to 102 years old, most of them (53.5%) were age 65 to 74 years old, followed by those age between 75 and 84 years old (37.3%). Over 70% of the recruitment received low education with 24.3% were illiterate and 49.1% were only elementary school educated. The rest of them were 12.3% junior high school educated, 9.4% high school educated, and 4.9% college or university educated.
Among 19,164 of the Kaigo Yobo checklist recruitment, 32.9% were Hakka speaking population. The Taiwanese and Mandarin speaking population made up another 36.5% and 30.0% recruitment.
The religion of them were mostly general folk belief (57.7%) like Taoism or Buddhism while the other religions made up another 8.5% with Christian 1.5%, Catholic 0.4%, and 6.6% of religion other than noted above. But surprisingly, nearly one third (33.8%) of the community elders were non-religious.
41
Majority (83.2%) of the enrollees were married but those unaccompanied were unmarried (1.3%), widowed or widower (14.8%), divorced (0.6%), or other (0.2%).
Most of the community elders were living with their spouse (22.1%) or progeny (21.4% with children and 50.8% with children and grandchildren), but there were still 5.7% of elders living alone in the community, nevertheless.
Though most (95.8%) of the elders were retired or not getting to work by then, however, there were 4.2% of elders still able to retain a job. Their economic status was generally stable but 248 cases were qualified for low-to-middle income (0.8%) or low income (0.5%) household.
Among 19,164 of total recruitment, 1.2% of them were disabled certified and possessed Disability Card (身心障礙手冊).
Table 4.5 General demographic status of Kaigo Yobo checklist enrollees (n=19,164)
Frequency Percentage (%) Genders
Female Male
9,764 9,400
50.9 49.1 Aborigines
No
Yes 18,988
716 99.1
0.9 Age
65 below 65~74 75~84 85 & above
107 10,261 7,152 1,644
0.6 53.5 37.3 8.6 Education
Illiterate Primary school Junior high school High school College and above
4,648 9,412 2,352 1,809 943
24.3 49.1 12.3 9.4 4.9
42
Table 4.5 continue
Frequency Percentage (%) Language Used
Mandarin Taiwanese Hakka
Aboriginal mother tongue Other
6,310 7,001 5,764 73 34
32.9 36.5 30.0 0.4 Religions 0.2
Non-religious General folk beliefs Christian
Catholic Other
6,472 11,060 282 82 1,264
33.8 57.7 1.5 0.4 6.6 Marital status
Unaccompanied Unmarried
Widowed or widower Divorced
Other Accompanied
3,228 246 2835 110 37 15,936
16.8 1.3 14.8 0.6 0.2 83.2 Living
Arrangement Solitary Cohabit
Nuclear Family Extended Family
1,092 4,222 4,110 9,740
5.7 22.1 21.4 50.8 Occupation
Unemployed Employed
796 18,368
4.2 95.8 Economic
status Non-disadvantaged Disadvantaged Low
Low-to-middle
18916 248 101 147
98.7 1.3 0.5 0.8 Disabled
certified Non-disabled Disabled
18,937 227
98.8 1.2
43
II. Prevalence of the Long-term Care Needs in Potential
Among 19,164 elder community dwellers, 2.4% of them might have long-term care requirement some times in their future life. Further investigation the study found that the potential risk on physical activities functioning was the highest amongst the others, with 8.6% of recruitment might suffer from it. Besides, potential risk in the aspect of oral health was fairly high as 5% of the recruitment were positively predicted to be at risk. Furthermore the prevalence of being undernourished were 1.3%.
The depression was worth notable as 2.7% of the community elders were potentially at risk of being depressed in future.
The details showed as Table 4.6.
Table 4.6 The distribution of long-term care needs in potential (n=19,164) Frequency Percentage (%) Long-term care needs in potential
Positive Negative
453 18,711
2.4 97.6 Potential risk on depression
Positive Negative
527 18,637
2.7 97.3 Potential risk on activities functioning
Positive Negative
1,641 17,523
8.6 91.4 Potential risk on nutrition
Positive Negative
258 18,906
1.3 98.7 Potential risk on oral health
Positive Negative
953 18,211
5.0 95.0
44
From the cross reference analysis of both AD-8 and Kaigo Yobo checklist
screening, the potential risks on depression and physical activities functioning, as well as oral health were far more higher among suspected MCI cases, although the risks probability on respective domains were higher than other domains of care needs for those cognitively normal cases, too.
Table 4.7 Cross reference of AD-8 and Kaigo Yobo checklist screening MCI
Value p a Positive (%)
(n=109)
Negative (%) (19,055) Long-term care needs in
potential Negative
Positive
74(67.9) 35(32.1)
18,637(97.8) 418(2.2)
420.287 0.000
Potential risk of depression
Negative Positive
72(66.1) 37(33.9)
18,565(97.4) 490(2.6)
398.896 0.000
Potential risk on physical
activities functioning Negative Positive
51(46.8) 58(53.2)
17,465(91.7) 1,590(8.3)
204.587 0.000
Potential risk of malnutrition
Negative Positive
103(94.5) 6(5.5)
18,803(98.7) 252(1.3)
14.272 0.000
Potential risk on oral health
Negative Positive
78(71.6) 31(28.4)
18,133(95.2) 922(4.8)
127.757 0.000
a Based on χ2 test for the difference in examined categorical variables of participants with MCI positive and MCI negative
45
III. Bivariate Analysis of Cases with Potential Long-term Care Needs From the Table 4.8, it was found that the potential long-term care needs was correlated with gender, age, ethnicity, educational level, marital status, living arrangement, economic status, and disabled certified.
Further investigation found that the ethnicity, educational level, and marital status were correlated with the specific domains of long-term care needs including risk of depression, physical activities functioning, nutrition, and oral health. Age, gender, economic status, and disabled certified, by another hand, correlated with three respective domains but not risk on nutrition. Living arrangement was correlated with risk of physical activities functioning, oral health and risk on nutrition but not risk of depression while the job availability was correlated with risk of physical activities functioning and risk on nutrition but not risk of depression and oral health. The details were shown below in regard of the potential risk on depression (Table 4.9), physical activities functioning (Table 4.10), nutrition (Table 4.11), and oral health (Table 4.12), respectively.
46
Table 4.8 Comparison of differences of potential long-term care needs according general demographic status (n=19,164)
Potential needs
Value p Value a Positive (%)
(n=453)
Negative (%) (n=18,711) Genders
Female Male
256(56.5) 197(43.5)
9,508(50.8) 9,203(49.2)
5.744 0.017
Aborigines
No Yes
446(98.5) 7(1.5)
18,542(99.1) 169(0.9)
2.004 0.157
Language
Used Mandarin
Taiwanese Hakka Other
125(27.6) 186(41.1) 135(29.8) 7(2.5)
6,185(33.1) 6,815(36.4) 5,611(30.0) 100(0.5)
14.709 0.002
Age
68 & below 69~72 73~79 80 & above
27(6.0) 53(11.7) 79(17.4) 294(64.9)
4,428(23.7) 5,010(26.8) 4,172(22.3) 5,101(27.3)
324.967 0.000
Educational
levels Illiterate
Elementary school Junior high school High school College and above
198(43.7) 184(40.6) 37(8.2) 31(6.8) 3(0.7)
4,450(23.8) 9,228(49.3) 2,315(12.4) 1,778(9.5) 940(5.0)
106.004 0.000
Marital status
Unaccompanied Accompanied
170(37.5) 283(62.5)
3,058(16.3) 15,653(83.7)
141.708 0.000
Living
arrangement Solitary Cohabit Nuclear family Extended family
28(6.2) 76(16.8) 94(20.8) 255(56.3)
1,064(5.7) 4,146(22.2) 4,016(21.5) 9,485(50.7)
8.836 0.032
47
Table 4.8 continue
Potential needs
Value p Value a Positive(%)
(n=453)
Negative (%) (n=18,711) Occupation
Unemployed Employed
438(96.7) 15(3.3)
17,930(95.8) 781(4.2)
0.827 0.363
Economic
status Non-disadvantaged Disadvantaged
426(94.0) 27(6.0)
18,490(98.8) 221(1.2)
79.086 0.000
Disabled
certified Non-disabled Disabled
391(86.3) 62(13.7)
18,566(99.1) 165(0.9)
619.560 0.000
a Based on χ2 test for the difference in examined categorical variables of participants with MCI positive and MCI negative.
48
Table 4.9 Comparison of differences of risk of depression according general demographic status (n=19,164)
Risk of depression
Value p Value a Positive (%)
(n=527)
Negative (%) (n=18,637) Genders
Female Male
298(56.5) 229(43.5)
9,466(50.8) 9,171(49.2)
6.792 0.009
Aborigines
No Yes
517(98.1) 10(4.8)
18,471(99.1) 166(0.9)
5.709 0.017
Language
Used Mandarin
Taiwanese Hakka Other
135(25.6) 257(48.8) 128(24.3) 7(1.3)
6,175(33.1) 6,744(36.2) 5,618(30.1) 100(0.5)
46.612 0.000
Age
68 & below 69~72 73~79 80 & above
93(17.6) 115(21.8) 110(20.9) 209(39.7)
4,362(23.4) 4,948(26.5) 4,141(22.2) 5,186(27.8)
37.551 0.000
Educational
levels Illiterate
Elementary school Junior high school High school College and above
157(29.8) 245(46.5) 64(12.1) 40(7.6) 21(4.0)
4,491(24.1) 9,167(49.2) 2,288(12.3) 1,769(9.5) 922(4.9)
10.546 0.032
Marital status
Unaccompanied Accompanied
129(24.5) 398(75.5)
3,099(16.6) 15,538(83.4)
22.547 0.000
Living
arrangement Solitary Cohabit Nuclear family Extended family
37(7.0) 127(24.1) 119(22.6) 244(46.3)
1,055(5.7) 4,095(22.0) 3,991(21.4) 9,496(51.0)
5.223 0.156
49
Table 4.9 continue
Risk of depression
Value p Value a Positive (%)
(n=527)
Negative (%) (n=18,637) Occupation
Unemployed Employed
499(94.7) 28(5.3)
17,869(95.9) 768(4.1)
1.830 0.176
Economic
status Non-disadvantaged Disadvantaged
499(94.7) 28(5.3)
18,417(98.8) 220(1.2)
68.525 0.000
Disabled
certified Non-disabled Disabled
494(97.7) 33(6.3)
18,443(99.0) 194(1.0)
119.352 0.000
a Based on χ2 test for the difference in examined categorical variables of participants with MCI positive and MCI negative
50
Table 4.10 Comparison of differences of risk on physical activities functioning according general demographic status (n=19,164)
Risk on physical activities
functioning Value p Value a Positive (%)
(n=1,641)
Negative (%) (n=17,523) Genders
Female Male
897(54.7) 744(45.3)
8,867(50.6) 8,656(49.4)
9.896 0.002
Aborigines
No Yes
1,624(99.0) 17(1.0)
17,364(99.1) 159(0.9)
0.273 0.602
Language
Used Mandarin
Taiwanese Hakka Other
544(33.2) 564(34.4) 515(31.4) 18(1.1)
5,766(32.9) 6,437(36.7) 5,231(29.9) 89(0.5)
12.821 0.005
Age
68 & below 69~72 73~79 80 & above
144(8.8) 257(15.7) 360(21.9) 880(53.6)
4,311(24.6) 4,806(27.4) 3,891(22.2) 4,515(25.8)
654.043 0.000
Educational
levels Illiterate
Elementary school Junior high school High school College and above
591(36.0) 723(44.1) 155(9.4) 118(7.2) 54(3.3)
4,075(23.2) 8,689(49.6) 2,197(12.5) 1,691(9.7) 889(5.1)
142.680 0.000
Marital status
Uncompanioned Companioned
505(30.8) 1,136(69.2)
2,723(15.5) 14,800(84.5)
248.621 0.000
Living
arrangement Solitary Cohabit Nuclear family Extended family
137(8.3) 291(17.7) 332(20.2) 881(53.7)
955(5.4) 3,931(22.4) 3,778(21.6) 8,859(50.6)
41.299 0.000
51
Table 4.10 continue
Risk on physical activities
functioning Value p Value a Positive (%)
(n=1,641)
Negative (%) (n=17,523) Occupation
Unemployed Employed
1,600(97.5) 41(2.5)
16,768(95.7) 755(4.3)
12.350 0.000
Economic
status Non-disadvantaged Disadvantaged
1,582(96.4) 59(3.6)
17,334(98.9) 189(1.1)
74.407 0.000
Disabled
certified Non-disabled Disabled
1,535(93.5) 106(6.5)
17,402(99.3) 121(0.7)
426.639 0.000
a Based on χ2 test for the difference in examined categorical variables of participants with MCI positive and MCI negative.
52
Table 4.11 Comparison of differences of risk on nutrition according general demographic status (n=19,164)
Risk on nutrition
Value p Value a Positive (%)
(n=258)
Negative (%) (n=18,906) Genders
Female Male
125(48.4) 133(51.6)
9,639(51.0) 9,267(49.0)
0.654 0.419
Aborigines
No Yes
237(91.9) 21(2.4)
18,751(99.2) 155(0.8)
149.865 0.000
Language
Used Mandarin
Taiwanese Hakka Other
40(15.5) 169(65.5) 28(10.9) 21(8.1)
6,270(33.2) 6,832(36.1) 5,718(30.2) 86(0.5)
385.324 0.000
Age
68 & below 69~72 73~79 80 & above
75(29.1) 58(22.5) 52(20.2) 73(28.36)
4,380(23.2) 5,005(26.5) 4,199(22.2) 5,322(28.1)
5.837 0.120
Educational
levels Illiterate
Elementary school Junior high school High school College and above
53(20.5) 146(13.6) 35(13.6) 20(7.8) 4(12.7)
4,595(24.3) 9,266(49.0) 2,317(12.3) 1,789(9.5) 939(5.0)
11.644 0.020
Marital status
Unaccompanied Accompanied
19(7.4) 239(92.6)
3,209(17.0) 15,697(83.0)
16.779 0.000
Living
arrangement Solitary Cohabit Nuclear family Extended family
9(3.5) 200(77.5) 12(4.7) 37(14.3)
1,083(5.7) 4,022(21.3) 4,098(21.7) 9,703(51.3)
470.622 0.000
53
Table 4.11 continue
Risk on nutrition
Value p Value a Positive (%)
(n=258)
Negative (%) (n=18,906) Occupation
Unemployed Employed
254(98.4) 4(1.6)
18,114(95.8) 792(4.2)
4.452 0.035
Economic
status Non-disadvantaged Disadvantaged
257(99.6) 1(3.3)
18,659(98.7) 247(1.3)
1.682 0.195
Disabled
certified Non-disabled Disabled
254(98.4) 4(1.6)
18,683(98.8) 223(1.2)
0.299 0.584
a Based on χ2 test for the difference in examined categorical variables of participants with MCI positive and MCI negative
54
Table 4.12 Comparison of differences of risk of oral health according general demographic status (n=19,164)
Risk on oral health
Value p Value a Positive (%)
(n=953)
Negative (%) (n=18,211) Genders
Female Male
530(55.6) 423(44.4)
9,234(50.7) 8,977(49.3)
8.730 0.003
Aborigines
No Yes
944(99.1) 9(0.9)
18,751(99.2) 155(0.8)
149.865 0.000
Language
Used Mandarin
Taiwanese Hakka Other
273(28.6) 329(34.5) 344(36.1) 7(0.7)
6,037(33.2) 6,672(36.6) 5,402(29.7) 100(0.5)
19.745 0.000
Age
68 & below 69~72 73~79 80 & above
140(14.7) 210(22.0) 237(24.9) 366(38.4)
4,315(23.7) 4,853(26.6) 4,014(22.0) 5.029(27.6)
79.592 0.000
Educational
levels Illiterate
Elementary school Junior high school High school College and above
299(31.4) 454(47.6) 97(10.2) 75(7.9) 28(2.9)
4,349(23.9) 8,958(49.2) 2,255(12.4) 1,734(9.5) 915(5.0)
36.624 0.000
Marital status
Unaccompanied Accompanied
245(25.7) 708(74.3)
2,983(16.4) 15,228(83.6)
56.258 0.000
Living
arrangement Solitary Cohabit Nuclear family Extended family
62(6.5) 186(19.5) 187(16.6) 518(54.4)
1,030(5.7) 4,036(22.2) 3,923(21.5) 9,222(50.6)
8.039 0.045
55
Table 4.12 continue
Risk on oral health
Value p Value a Positive (%)
(n=953)
Negative (%) (n=18,211) Occupation
No Yes
911(95.6) 42(4.4)
17,457(95.9) 754(4.1)
0.162 0.687
Economic
status Non-disadvantaged Disadvantaged
926(97.2) 27(2.8)
17,990(98.8) 221(1.2)
18.597 0.000
Functional
abilities Normal Disabled
916(96.1) 37(11.3)
18,021(99.0) 190(1.0)
62.367 0.000
a Based on χ2 test for the difference in examined categorical variables of participants with MCI positive and MCI negative
56
IV. Risk Factors Analysis of Potential Long-term Care Needs
From the logistic regression analysis (Table 4.13), older age, low educational level, unaccompanied, living with more family members, low-income, and limited functional ability were found to be associated with increased risk of potential long-term care needs.
It was found that those age 69 to 72 were 1.737 (95% CI: 1.074 - 2.870) times higher, while those age 73 to 79 were 2.791 (95% CI: 1.763 - 4.410) times higher, and those age 80 and above were 8.634 (95% CI: 5.664 - 13.161) times higher risk in need of long-term care than those aged 68 and below, respectively. However, education was inversely associated with potential risk of long-term care needs as higher educated individuals were the less probability of long-term care supports in future life, the odd ratios ranged from 0.668 to 0.121, along with the increases of educational level. Those accompanied community elders were found 0.495 (95% CI: 0.395 - 0.619) times lower probability in need of long term care compared to those unaccompanied elders.
Those positively predicted cases having probable long-term care needs in potential were mostly living with either their spouses or children (odd ratios ranged from 1.630 to 2.023 along with the increase of cohabitant members). The disadvantaged (OR:
4.231, 95% CI: 2.637 - 6.786) and disabled (OR: 14.909, 95% CI: 10.576 - 21.048) were also found to be more vulnerable and higher risk of being in need of long-term care in future.
57
Table 4.13 Predictors of long-term care needs in potential: result of logistic regression analysis
OR 95% CI p Value
Genders
Female Male
1
0.860 0.690 1.071 0.178 Aborigines
No Yes
1
1.566 0.595 4.116 0.363 Language used
Mandarin Taiwanese Hakka Others
1 1.187 1.028 2.454
0.924 0.784 0.915
1.527 1.350 6.579
0.180 0.840 0.074 Age
68 & below 69~72 73~79 80 & above
1 1.737 2.791 8.634
1.074 1.763 5.664
2.870 4.420 13.161
0.024 0.000 0.000 Educational levels
Illiterate Primary school Junior high school High school College and above
1 0.668 0.558 0.737 0.121
0.534 0.381 0.486 0.038
0.835 0.819 1.116 0.387
0.000 0.003 0.150 0.000 Marital status
Unaccompanied Accompanied
1
0.495 0.395 0.619 0.000 Living arrangement
Solitary Cohabit Nuclear family Extended family
1 1.630 1.812 2.023
0.999 1.132 1.299
2.660 2.901 3.152
0.051 0.013 0.002 Employment
No Yes
1
1.249 0.725 2.150 0.423 Economic status
Non-disadvantaged Disadvantaged
1
4.231 2.637 6.786 0.000 Disabled certified
Non-disabled Disabled
1
14.909 10.576 21.018 0.000
58
On specific domains, females were founded to be more vulnerable to depression (OR: 1.312, 95% CI: 1.082 - 1.592) and physical abilities functioning (OR: 1.240, 95% CI: 1.102 - 1.394). The aboriginal population was found higher potential risk on nutrition (OR: 2.400, 95% CI: 1.101 - 5.235) when compared to non-aboriginal community elders. The Taiwanese speaking elders were higher potential risk on depression (OR: 1.754, 95% CI: 1.406 - 2.188), and nutrition (OR: 4.490, 95% CI:
3.139 - 6.423) but lower risk on physical activities functioning (OR: 0.874, 95% CI:
0.764 - 0.998) while the Hakka speaking elders were higher risk on oral health (OR:
1.277, 95% CI: 1.074 - 1.519) when compared to Mandarin speaking population.
There was a trend that higher age was associated with higher potential risk in specific domains of long-term care needs including depression (Table 4.13), physical activities functioning (Table 4.14), and oral health (Table 4.16) but not nutrition (Table 4.15). A protecting effect was found on educational level in regard of risk on physical activities functioning (Table 4.14) and college above educated elders were found lower risk on oral health (OR: 0.626, 95% CI: 0.416 - 0.942).
The alliance, was protecting community elders from depression (OR: 0.769, 95%
CI: 0.611 - 0.968), risk on physical activities functioning (OR: 0.596, 95% CI: 0.523 - 0.678), and oral health (OR: 0.683, 95% CI: 0.577 - 0.808) but not malnutrition (OR:
1.787, 95% CI: 1.058 - 3.018). Furthermore, the risk of undernourished was also found to be higher among individuals cohabited with spouse (OR: 3.741, 95% CI:
1.807 - 7.744) but lower among those living with other of their family members and relatives.
The unemployed elders were higher risk on malnutrition (OR: 2.298, 95% CI:
0.109 - 0.811) while the disadvantaged elders were more vulnerable to depression (OR: 3.802, 95% CI: 2.481 - 5.828), physical activities functioning (OR: 2.899, 95%
CI: 2.087 - 4.026), and oral health (OR: 2.108, 95% CI: 1.388 - 3.201). The disabled, on the other hand, were more vulnerable to depression (OR: 4.899, 95% CI: 3.296 - 7.282), physical activities functioning (OR: 9.143, 95% CI: 6.854 - 12.195), and oral health (OR: 3.315, 95% CI: 2.297 - 4.783).
The details were showed in Table 4.14 to Table 4.17 for risk on depression, physical activities functioning, nutrition, and oral health, respectively.
59
Table 4.14 Predictors of depression: result of logistic regression analysis
OR 95% CI p Value
Genders
Female Male
1
0.762 0.628 0.924 0.006 Aborigines
No Yes
1
1.829 0.849 3.939 0.123 Language used
Mandarin Taiwanese Hakka Others
1 1.754 1.078 1.757
1.406 0.832 0.687
2.188 1.395 4.497
0.000 0.567 0.240 Age
68 & below 69~72 73~79 80 & above
1 1.151 1.301 2.053
0.867 0.973 1.574
1.526 1.740 2.677
0.330 0.076 0.000 Educational levels
Illiterate Primary school Junior high school High school College and above
1 0.967 1.099 0.993 1.004
0.779 0.803 0.683 0.619
1.199 1.503 1.444 1.630
0.759 0.556 0.970 0.986 Marital status
Unaccompanied Accompanied
1
0.769 0.611 0.968 0.025 Living arrangement
Solitary Cohabit Nuclear family Extended family
1 1.209 1.093 0.983
0.803 0.731 0.670
1.820 1.635 1.443
0.364 0.666 0.932 Employment
No Yes
1
1.415 0.952 2.102 0.086 Economic status
Non-disadvantaged Disadvantaged
1
3.802 2.481 5.828 0.000 Disabled certified
Non-disabled Disabled
1
4.899 3.296 7.282 0.000
60
Table 4.15 Predictors of risk of physical activities functioning: result of logistic regression analysis
OR 95% CI p Value
Genders
Female Male
1
0.806 0.717 0.907 0.000 Aborigines
No Yes
1
1.124 0.619 2.041 0.702 Language used
Mandarin Taiwanese Hakka Others
1 0.874 0.957 1.978
0.764 0.832 1.077
0.998 1.100 3.633
0.047 0.533 0.028 Age
68 & below 69~72 73~79 80 & above
1 1.556 2.555 5.363
1.257 2.080 4.428
1.925 3.138 6.495
0.000 0.000 0.000 Educational levels
Illiterate Primary school Junior high school High school College and above
1 0.792 0.697 0.757 0.628
0.699 0.571 0.605 0.462
0.897 0.850 0.947 0.854
0.000 0.000 0.015 0.003 Marital status
Unaccompanied Accompanied
1
0.596 0.523 0.678 0.000 Living arrangement
Solitary Cohabit Nuclear family Extended family
1 0.911 1.013 1.082
0.715 0.803 0.872
1.159 1.278 1.342
0.448 0.913 0.475 Employment
No Yes
1
0.795 0.572 1.105 0.172 Economic status
Non-disadvantaged Disadvantaged
1
2.899 2.087 4.026 0.000 Disabled certified
Non-disabled Disabled
1
9.143 6.854 12.195 0.000
61
Table 4.16 Predictors of malnutrition: result of logistic regression analysis
OR 95% CI p Value
Genders
Female Male
1
0.950 0.723 1.249 0.713 Aborigines
No Yes
1
2.400 1.101 5.235 0.028 Language used
Mandarin Taiwanese Hakka Others
1 4.490 1.264 25.997
3.139 0.769 11.154
6.423 2.077 60.591
0.000 0.355 0.000 Age
68 & below 69~72 73~79 80 & above
1 0.790 0.912 1.120
0.546 0.620 0.778
1.144 1.343 1.614
0.212 0.642 0.543 Educational levels
Illiterate Primary school Junior high school High school College and above
1 1.237 1.361 1.080 0.396
0.881 0.854 0.621 0.140
1.736 2.169 1.880 1.125
0.219 0.194 0.785 0.082 Marital status
Unaccompanied Accompanied
1
1.787 1.058 3.018 0.030 Living arrangement
Solitary Cohabit Nuclear family Extended family
1 3.741 0.212 0.333
1.807 0.086 0.154
7.744 0.524 0.722
0.000 0.001 0.005 Employment
No Yes
1
2.298 0.109 0.811 0.018 Economic status
Non-disadvantaged Disadvantaged
1
0.160 0.020 1.254 0.081 Disabled certified
Non-disabled Disabled
1
1.494 0.522 4.275 0.454
62
Table 4.17 Predictors of risk on oral health: result of logistic regression analysis
OR 95% CI p Value
Genders
Female Male
1
0.865 0.748 1.000 0.050 Aborigines
No Yes
1
1.072 0.508 2.265 0.854 Language used
Mandarin Taiwanese Hakka Others
1 1.017 1.277 1.313
0.857 1.074 0.556
1.207 1.519 3.104
0.843 0.006 0.535 Age
68 & below 69~72 73~79 80 & above
1 1.279 1.679 2.096
1.026 1.347 1.698
1.596 2.093 2.586
0.029 0.000 0.000 Educational levels
Illiterate Primary school Junior high school High school College and above
1 0.902 0.827 0.882 0.626
0.769 0.646 0.669 0.416
1.058 1.059 1.164 0.942
0.206 0.132 0.376 0.025 Marital status
Unaccompanied Accompanied
1
0.683 0.577 0.808 0.000 Living arrangement
Solitary Cohabit Nuclear family Extended family
1 1.122 1.098 1.197
0.815 0.803 0.894
1.544 1.500 1.603
0.480 0.559 0.227 Employment
No Yes
1
1.249 0.904 1.725 0.178 Economic status
Non-disadvantaged Disadvantaged
1
2.108 1.388 3.201 0.000 Disabled certified
Non-disabled Disabled
1
3.315 2.297 4.783 0.000
63
Chapter 5 Discussion
Section 1 Study Findings I. General Demographic Findings
This study was aimed to investigate the prevalence of Mild Cognitive
Impairment (MCI) among elder community dwellers and related long-term care needs in potential through Routine Health Check-up for Elderly that performed in 2012 from anonymous county in northern Taiwan. Recruited primarily from community health promotion activities held by local primary health care centers, 40,140 and 19,164 elders completed AD-8 and Kaigo Yobo checklist screening respectively, and enrolled into this study.
Generally, the elder population who was still able living in the community was mainly population age between 65 to 74 with considerably low educational level. The distribution of the different languages speaking population including Mandarin, Taiwanese, and Hakka were fairly average although the aboriginal population was only constituted only small part of the recruitment. Most of the elders were married or accompanied, living with their children. Majority of them were retired or unable to work due to functional disability.
II. The MCI Prevalence
The estimated prevalence of MCI varied around the world, ranged from 0.6% to 23.7% (Sosa et al., 2012; Stephan, et al., 2007; Busse et al., 2003; Ritchie et al., 2003;
Das et al., 2007; Tognoni et al., 2005; Meguro et al., 2004; Hanninen, et al., 2002;
Lopez et al., 2003, Lee et al., 2011; Kim et al., 2011). In this study, 579 cases among 40,140 elder community dwellers were positively screened as suspected MCI and the prevalence rate was found to be 1.4%.