| Summary: | 碩士 === 國立陽明大學 === 傳統醫藥研究所 === 103 === Introduction: Few studies have reported on the utilization of Integrative Medicine (IM) among dementia patients and the protective effect of IM on pneumonia admission. The aim of the present study is to analyze factors associated with IM users in the dementia populations and to determine whether IM therapy would decrease pneumonia admission risk in elderly people with dementia. Materials and Methods: At the crosectional study, a total of 18,141 dementia patients were screened from Longitudinal Health Insurance Database 2005 (LHID2005), which contains all the original claim data of 1,000,000 beneficiaries, randomly sampled from the year 2005 Registry for Beneficiaries of the National Health Insurance Research Database. The dementia patients were then divided into IM users and non-IM users according to their medical records between 1995 and 2008. Demographic characteristics included gender, age, insured amount, and geographic location and medical conditions including comorbidity diseases, behavioral and psychological symptoms, and anti-dementia medication were also investigated. Their tendency of IM usage was investigated using a multilevel longitudinal Poisson regression model. At longitudinal study, we conducted a retrospective cohort study. 6712 new diagnosis dementia patients without pneumonia from January 1997 to December 2003 were obtained from the LHID2005. After matching by gender, age, urban level, Charlson comorbidity index, insured amount, and comorbidity, a total of 1376 pairs (1:1) of IM users and IM non-users were acquired. Each patient was individually tracked from 1997 to 2012 to identify pneumonia incidence (onset after 3 month of dementia diagnosis). Demographic characteristics, Charlson comorbidity index, comorbidity, behavioral and psychological symptoms of dementia, psychotropic drugs were also investigated. Cox proportional regression models were performed to compute hazard ratios and the accompanying 95% confidence intervals after adjustment for the variables mentioned. v Results: In Taiwan, 43.3% dementia patients had sought IM treatments. The inclination of IM usage was inversely proportional to age; the younger and early-onset dementia (age less than 55 years) patients constituted the high usage group. Female, living in central Taiwan, and higher insured amount were also associated with higher tendency of IM use. Multilevel Poisson regression analysis showed that the odds ratios (OR) of IM use were 1.80 (95% CI = 1.68-1.94), 2.52 (95% CI = 2.30-2.76), 3.41 (95% CI = 3.01- 3.86) for those with one, two, three or more behavioral and psychological symptoms of dementia (BPSD), respectively compared with dementia sufferers without BPSD. In additional, polypharmacy led to higher utilization of IM (two type: Adjust OR = 1.41, 95% CI = 1.28-1.56, three types: Adjust OR = 1.97, 95% CI = 1.63-2.00; four or more types: Adjust OR =2.95, 95% CI = 2.27-2.78). In the matched cohort of the second part, there were 419 cases (30.5%) of pneumonia in the IM cohort and 762 cases (55.4%) in the non-IM cohort identified during the average 7.6-year follow-up period. Comparing with patients reciced Western Medidine only, The multivariate-adjusted hazard ratios for pneumonia admission was 0.62(95% CI =0.55-0.70) for patients with IM treatments. Patients received IM therapy for higher cumulative doses or time experienced more protection from pneumonia admission. Ma-Xing-Gan-Shi-Tang, Yin-Qiao-San, and Xiao-Qing-Long-Tang might be the possible formulae reducing the incidence of pneumonia. Conclusion: More than 40% of the dementia patients in Taiwan used IM. Young-onset dementia, higher number of BPSD, multiple chronic diseases, and polypharmacy were independent predictors for dementia patients seeking IM medical advice. The present results suggest that IM might be associated with a reduced risk of pneumonia in dementia patients.
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