A Study of the Impact of the Aging Related Health Issues in the Elderly

• Main Authors: Hsiao Peng- Ching, 蕭鵬卿
• Other Authors: Wang Kwua-Yun
• Format: Others
• Language: en_US
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/01268691805557074939

博士 === 國防醫學院 === 醫學科學研究所 === 103 === Background: Taiwan has the fastest aging rate among developed countries, elderly care for the elderly is becoming more common in the country. The elderly with aging disease related issues and the impact of those issues were needed medical practioners to pay more attention. Chronic obstructive pulmonary disease (COPD), an age-related disease, is a major public health problem with high morbidity and mortality and can be a long-term burden for family members; Primary family caregivers play an important role in patient health and health promotion behavior. However, little attention has been given to the differences in COPD care between elder caregivers and other caregivers. Osteoporosis, which is also identified as an age-related disease, is one of the major cause of fracture and repeated fracture among elderly. Thus we designed two studies based on the elderly with aging disease related issues and the impact of those issues. First study aimed to investigate the differences between elder family caregivers and non-elder family caregivers caring for COPD patients in Taiwan, including caring behavior, caregiver response, and caring knowledge. The second study aimed to explore the incidence and risk factors of repeated osteoporotic fracture(ROF) in Taiwan. Methods: In first cross-sectional study, primary family caregivers of COPD patients from 6 hospitals in north-central Taiwan were recruited to answer questionnaires measuring COPD characteristics, care behavior, caregiver response, and COPD knowledge. All questionnaires were shown to have acceptable validity and reliability, and the data were analyzed using univariate and generalized linear model techniques. The second study is a retrospective cohort study using Taiwan National Health Insurance database 1995 through 2011. Individuals aged 65 years or older who experienced initial osteoporotic fracture(OF) were included. Patients were followed until death, end of registration in NHIRD, ROF occur or end of study period (December 31, 2011), whichever occurred first. Incidence of ROF after initial fracture in 5 years or above were analysed. We assessed risk factors for ROF using Cox proportional hazards models. Results: The COPD-related knowledge scale results were positively correlated with the family caregiver caring behavior scale, suggesting that better COPD-related knowledge among family caregivers may result in improved caring behavior. After adjusting for all possible confounding factors, the elder caregivers had significantly lower COPD-related knowledge than the non-elder caregivers (P<0.001). However, there were no significant differences in the family caregiver caring behavior scale or the caregiver reaction assessment scale between the two groups. The incidence rate of ROF subjects were 950.5, 321.4, 158.7, 92.8 and 70.2 per 1000 person year in the first, second, third fourth and fifth year, respectively. Nearly 45% subjects get ROF in 1 year after first OF. ROF risk increased with age, and Charlson Comorbidity Index (CCI). Subjects who were female, hip and vertebral fracture at first time OF, recived OF related operations and bone related medication had more risk in ROF. Conclusions: The impact of the elderly with aging disease is huge, not only to their family caregivers but also to themselfes. We found elder family caregivers require increased education regarding medications and preventive care in COPD patient care. In addition, the incidence of Taiwanese elder with ROF is higher in first year after initial OF, and ROF risk increase with age, female sex, high CCI score, recieved OF related operations, hip or vertebral fracture, and used bone related medication.