| Summary: | 碩士 === 國防醫學院 === 公共衛生學研究所 === 90 === Population aging increases the problems of mental and physical disability, which results in the increasing needs of health care. There are a number of healthcare services according to the different care needs. Institutional long-term care (LTC) is one of the most necessaries. In recent years, the evaluation of the LTC service mainly focuses on the measurements of the use of health utilities for the recipients, such as health-related quality of life (HRQOL), health values, and preferences for health, etc.
This study is to understand the health utility of the elders receiving institutional LTC, to discuss the analytic effect the important factors, and to suggest to services improving, polices making, and further studies. This is a longitudinal survey research. The data is collected by the interviews through the face-to-face interviews with structured questionnaire and visual aid. The questionnaire contains the personal information, full texture of WHO-HRQOL-BRIEF (Taiwan vision), questions of rating scales (RS) and time-trade-off (TTO) methods.
Study data were collected from 188 elder residents in 26 nursing homes, and 209 in 26 resident houses in the 7 counties in North Taiwan during December 1 of 2001 to March 31 of 2002. Data were analyzed with SPSS 10.0 for windows (Frequency, Percentage, Chi-square Test, Independent Samples T-test, One-way ANOVA, Pearson’s Correlation Coefficient, Step-wise Regression). The main results of this study are as followings.
1.The elder residents aged 79.3 in average, with 226 male (56.9%) and 171 female (43.1%). Most of them are from Taiwan (53.0%) and Mainland China (41.4%). About 80% (79.1%) elder residents are religious, and the majority of them believe in Taoism. (39.6%) Most of the elder residents are primarily educated or below. About 60% (59.0%) elder residents are widows or widowers. The majority of the elder residents (26.5%) worked as householders before.
2.The results of the elder residents’ HRQOL evaluation are as follow. They score d 3.13 points (1-5) on general QOL, and 2.84 on general health. The best 3 items are “physical safety and security,” “physical environment,” “social care accesses,” while the worst 3 items are “leisure opportunities,” and “physical abilities,” “positive feelings.” Their HRQOL evaluations in the order of domain scores are “Environment,” “Social Relations,” “Physical Health,” and “Physiological Domain.”
3.In RS question, the elder residents rated their present health status at 58.6 points (0-100). Their scores of rating given dummy ones in 5 level of health status by Karnofsky Scale are 88.8 to level 0, 72.0 to level 1, 56.5 to level 2, 37.4 to level 3, and 18.2 to level 4.
4.In TTO questions, about half of the elder residents (45.9%) are willing to trade off when asked to choose between “a 10-year life in present health status” and “a shorter but most healthy life.” In addition, their “TTO years” is 4.9 in average. In other worlds, the mean health utility value is 0.49.
5.The most important factors that effect the self-rated health values of the elder residents include “self-perceived mental health status,” “activity of daily living,” “frequency of OPD,” “frequency of fall” et al., which explain 78.8% of the variance of the elder residents’ self-rated health values.
Based on these results, some suggestions are made as follow for LTC services administration, related policies, and further studies.
1.For institutional LTC service, it is suggested to make clear the roles of different types of service providers to ensure the accuracy of human resources allocations. It’s also suggested that the government should make policies on regulating the LTC service administration, especially the quality of structure aspect of LTC services. Besides, people should make preparations in advance for population aging, such as the chronic diseases preventions or health promotions.
2.I propose further studies to explore or focus on the elder resident with some special conditions, and to put some macro-societal variables in analyses and discussions of HRQOL relation.
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