| Summary: | 碩士 === 國立陽明大學 === 公共衛生研究所 === 103 === Objectives : In recent years the population of the incompetent elderly who rely on artificial enteral feeding to survive has been increasing because of improved medical facilities and ageing population in Taiwan. The objectives of this study are to analyze the characteristics of these people and to conduct survival analysis.
Methods: The method used in this research was a retrospective chart review of all artificial tube-fed cases, older than 65 years old who started to receive home-care services of National Yang-Ming University Hospital, Yilan County between January 1, 2009 and September 30, 2014. Descriptive statistics were used to summarize the characteristics of all cases. Multivariate survival analysis using stepwise Cox’s regression model was performed. Then the results for different kinds of care places and primary caregivers were compared.
Results: There are 519 cases using artificial tube feeding in total. During the study period, 221 deaths (42.6%) occurred, and 60 cases (11.6%) had gotten better without relying on artificial feeding. The mean survival time of these 519 cases was 793.5 days. The first four main diagnoses were stroke 51.6%, dementia 17.1%, Parkinson's disease 6.0%, and cancer 6.0%. For care places (after adjustment for other factors except caregivers), comparing with the Home group the hazard ratio (HR) of the Institution group was 0.414 (95% CI 0.268-0.638). The results of the final Cox-regression Model are shown as follows. For every one year increase in initial age, risk of death increased by 4.0% (HR: 1.040, 95% CI: 1.021-1.061). The death risk was nearly 0.8 times higher in male than in female cases (HR: 1.827, 95% CI: 1.383-2.414). The HR for every one point increase in GCS eye score was 0.707 (95% CI: 0.601- 0.831). When the cases initially diagnosed with pressure ulcers, cancer, or renal disease, the HR was raised to 2.299 (95% CI: 1.389- 3.807), to 2.507 (95% CI: 1.575 -3.989), or to 2.888 (95% CI: 1.335- 6.247) respectively. For primary caregivers, comparing with in-home family caregivers the HR for personnel in long-term care institutions, for foreign in-home caregivers, or for Taiwanese in-home caregivers was 0.441 (95% CI: 0.298- 0.654), 0.567 (0.383-0.838 95% CI), or 0.324 (95% CI: 0.077-1.367) (the lowest, but not significant) respectively.
Conclusions: Based on the results, old age, male gender, low GCS eye score, initial diagnoses of pressure ulcers, cancer, or renal disease, or home-care settings can increase the risk for death. The advantages of institutions might be associated with professional training for healthcare personnel, sufficient rest between shift assignments, consultation with nutritionists, and profit from care. Among four kinds of caregivers, personnel in long-term care institutions, foreign in-home caregivers and Taiwanese in-home caregivers had let to better survival of cases than in-home family caregivers.
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