[[alternative]]Factors Associated with Perceived Constipation and Health Care Utilization in the Elderly--A Study in the Yunlin-Chiayi Region, Taiwan

[[abstract]] 背景／目的：高齡化社會引起的健康照護需求議題非常值得重視。其中，老人便秘造成的醫療費用與用藥支出增加問題，更是當務之急。本研究目的在於探究影響自覺銀髮族便秘之因子，以及其使用不同種類的醫療之相關因子。 方法： 本研究採橫斷式問卷調查，於2017年4至9月期間對居住在雲嘉地區65至85歲自覺有便秘症狀的銀髮族，進行面對面問卷訪談，完成有效樣本369位(92.25%有效問卷完成率)。 結果：銀髮族受訪者中61.0%為女性、55%沒有每天排便、77.5%至少罹患一種以上慢性疾病，其中以高血壓最多(48.8%)。74.3%至少服用一種以上西藥，以使用降血壓藥物最多(47.7%)。平均便秘病患生活品質評估量表分數為34.4±14.3分，進一步分析沒有每天排便者，量表總分顯著高於每天排便者(38.9±14.1分 vs 28.8±12.6分, P<0.001)。其中，健康狀況不好者(P<0.001)、服用西藥兩種以上者(P=0.04)、罹患蕁麻疹(P=0.013) 、有更年期症候群者(P=0.008)、服用過敏藥物者(P=0.025)、控制血糖藥物者(P=0.040)、口服軟便(P=0.002)、口服瀉藥(P<0.001)、使用塞劑(P=0.004)與灌腸(P=0.001)藥物者、經常使用健康食品(P=0.049)、益生菌(P=0.003)、調理飲食(P=0.001)、偶爾使用按摩(P=0.004)等族群與量表總分呈現正相關。另外，以多變項邏輯斯複迴歸分析影響銀髮族是否每天排便的因子，顯示與學歷、運動習慣、罹患糖尿病、服用口服軟便藥物、灌腸藥物、吃中藥及健康食品者等呈現顯著相關性。 結論：參與研究的銀髮族便秘情形相當普遍，尤其是學歷低、沒有運動以及罹患糖尿病者為最。自覺便秘患者大多會尋求西醫治療或使用健康食品、益生菌及調理飲食等輔助醫療。本研究結果可提供醫療及健康照護單位在照護老人便秘患者時之參考；並可作為制定高齡照護醫療政策之依據。[[abstract]] Background/Aim: The issue of health care needs in an aging society deserves closer consideration/attention. The rise in medical cost and medication expenditure due to constipation in the elderly is particularly imperative. The aim of this study was to explore the factors associated with perceived constipation and its medical management among the elderly. Methods: A cross-sectional face-to-face questionnaire survey was administered to elderly people aged from 65 to 85 years with self-reported symptoms of perceived constipation in the Yunlin-Chiayi region from April to September, 2017. A total of 369 valid samples was obtained (92.25% completion rate). Results: Of the surveyed elderly, 61.0% were female, 55% had no daily bowel movement, and 77.5% had at least one chronic disease, of which hypertension was the most common (48.8%). In addition, 74.3% of them were using at least one type of conventional western medicine, of which antihypertensives were the most common (47.7%). The mean score of the Patient Assessment of Constipation Quality of Life (PAC-QOL) was 34.4 (SD±14.3), and the score was significantly higher among the elderly who did not have daily bowel movement compared with those who did (38.9±14.1 vs. 28.8±12.6, P<0.001). The score was significantly associated with poor health (P<0.001), taking two or more types of Western medications (P=0.04), urticaria (P=0.013), menopausal syndrome (P=0.008), anti-allergy medication (P=0.025), antihyperglycemic agents (P=0.040), oral stool softeners (P=0.002), oral laxative (P