Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
Arch Gerontol Geriatr. 2013 Sep-Oct;57(2):177-83. doi: 10.1016/j.archger.2013.04.011. Epub 2013 May 15.
Disability is associated with increased long-term care use among the elderly, but its association with utilization of acute care is not well understood. The aim of this study is to investigate the association between functional disability and acute medical care utilization among the elderly. This nationwide, population-based cohort study was based on data from the 2005 National Health Interview Survey (NHIS), linking to the 2004-2007 National Health Insurance (NHI) claims data. A total of 1521 elderly subjects aged 65 years or above were observed from the year 2004 to 2006; this sample was considered to be a national representative sample. The utilization of acute medical care (including outpatient services, emergency services, and inpatient services) and medical expenditure were measured. Functional disability was measured by determining limitations on activities of daily living (ADLs), instrumental activities of daily living (IADLs), and mobility. After adjusting for age, comorbidity, and sociodemographic characteristics, functional disability that affected IADLs or mobility was a significant factor contributing to the increased use of care. A clear proportional relationship existed between disability and utilization, and this pattern persisted across different types of acute care services. Disability affecting IADLs or mobility, rather than ADLs, was a more sensitive predictor of acute medical care utilization. Compared to elderly persons with no limitations, the medical expenditure of those with moderate-to-severe limitations was 2-3 times higher for outpatient, emergency, and inpatient services. In conclusion, functional disability among the elderly is a significant factor contributing to the increased use of acute care services.
残疾与老年人长期护理使用的增加有关，但它与急性护理的使用之间的关系尚未得到很好的理解。本研究旨在探讨功能障碍与老年人急性医疗保健利用之间的关系。这项全国性的基于人群的队列研究基于 2005 年全国健康访谈调查（NHIS）的数据，与 2004-2007 年国家健康保险（NHI）理赔数据相联系。共有 1521 名 65 岁或以上的老年人在 2004 年至 2006 年期间进行了观察；该样本被认为是一个全国代表性样本。测量了急性医疗保健（包括门诊服务、急诊服务和住院服务）的利用情况和医疗支出。功能障碍通过确定日常生活活动（ADL）、工具性日常生活活动（IADL）和活动能力的限制来衡量。在调整了年龄、合并症和社会人口特征后，影响 IADL 或活动能力的功能障碍是导致护理利用增加的一个重要因素。残疾与利用之间存在明显的比例关系，这种模式在不同类型的急性护理服务中都存在。影响 IADL 或活动能力的残疾而不是 ADL 是急性医疗保健利用的更敏感预测因素。与没有限制的老年人相比，中度至重度受限的老年人的门诊、急诊和住院服务的医疗支出是其 2-3 倍。总之，老年人的功能障碍是导致急性护理服务利用增加的一个重要因素。
