[[alternative]]Association Study between Co-morbidity Index and ADL Function -- in Case of Out-patients and In-patients of a Community Hospital in Northern Taiwan

[[abstract]]多重慢性病況及失能衝擊老年人的生活品質及長期照護需求，而台灣的老年失能問題已日趨嚴重。日常生活功能往往是評估許多醫療照護介入結果的重要內容，而罹病狀況對整體健康而言乃是一個強力之預測因子，同時也是流行病學上的重要中介、修正或干擾因子。本研究旨在瞭解長期失能老年人其日常生活功能與罹病情況的相關性。研究採橫斷式研究法，針對北台灣某社區醫院120位年滿65歲以上、失能超過6個月以上之失能老年病患，以訪談方式收集個案MDS-HC居家照護評估量表日常生活功能，透過病歷回顧方式收集人口學基本資料、健康功能相關資料、Quan版合併罹病症指數(Charlson co-morbidity Index by Quan, CCI-Q)、功能性罹病指數(Functional Co-morbidity Index, FCI)及日本介護保險法施行令中明訂16種提前或加速老化之疾病罹病數，再以皮氏積差相關係數(Pearson’s correlation coefficient)分析了解長期失能老年人罹病情況與日常生活功能的相關性。研究結果發現幾乎全數(99.2%)失能老年人罹患超過2種以上疾病狀況，38.3%失能老年人使用超過5大類以上之藥物。Quan版合併罹病症指數與MDS-HC居家照護評估量表日常生活功能得分呈顯著相關性(r = 0.314, p < 0.01)，日本介護保險法施行令所明訂16種加速或提早老化之疾病罹病數，與MDS-HC居家照護評估量表日常生活功能分數均呈顯著相關(r = 0.231, p < 0.05)，但功能性罹病指數與MDS-HC居家照護評估量表日常生活功能分數則未能顯現相關性(r = 0.027, p = 0.767)。由研究結果可知多重罹病情況及多重用藥普遍存在於國內之失能老年族群，且成熟度及可用性較高的Quan版合併罹病症指數與長期失能老年人的日常生活功能相關。本研究嘗試將臨床上常見之多重疾病罹患，透過Quan版合併罹病症指數之轉換機制，來建立其與日常生活功能之連貫或串連，相信對老年失能者照護問題的掌握有所裨益。本研究僅提供初步研究結果，仍需更多研究證實其合理性、通用性及結論性，以供日後廣泛應用或進一步研究之參考。[[abstract]]The disabled elderly groups in Taiwan has upgraded rapidly. Multiple chronic conditions and disabilities have posed lots of impacts on the quality of life and the needs of long-term care in the elderly. ADL function has usually been an important outcome of medical and care interventions. However, co-morbidity status has been regarded as a powerful predictor of the health outcome, as well as an important intermediate, modifier or confounder factors epidemiologically. The purpose of this study is to clarify the association of co-morbidity and the ADL function among long-term disabled elderly people. The design was a cross-sectional study in a Community Hospital in Northern Taiwan, recruiting 120 old adults aged 65 or older with ADL dependent for more than 6 months. In addition to basic information and co-morbidity indices [Charlson Co-morbidity Index by Quan(CCI-Q); Functional Co-morbidity Index(FCI), and the 16 categories of accelerating ageing morbidities derived from the Execution Act of Kaigo Hokien Ho in Japan] has been collected from the medical profiles in the hospital, we collected core data through interviewing the subjects’ functional ability has been assessed by the ADL function items of the Minimum Data Set for Home Care (MDS-HC). We analyzed the association by the Pearson’s correlation coefficients(r) amongst the ADL scores of the MDS-HC and the co-morbidity indices.The result showed that almost all of the disabled elderly (99.2%) suffered from more than 2 groups of morbidities and 38.3% of disabled elderly took more than 5 classes of medicine. Therefore, the estimated CCI-Q correlated with the ADL scores of the MDS-HC (r = 0.314, p < 0.01) and the 16 categories of accelerating ageing morbidities derived from the Execution Act of Kaigo Hokien Ho in Japan also correlated with the ADL scores of the MDS-HC(r = 0.231, p < 0.05), but the estimated FCI didn’t correlated with the ADL scores of the MDS-HC (r = 0.027, p = 0.767).In conclusion, the disabled elderly with multiple morbid conditions and polypharmacy be common in Taiwan. The development of the CCI-Q might yield mature, stable and feasible results whatever, such as correlation with the ADL function among long-term disabled elderly. The study tried to adopt certain mechanism of multiple morbid conditions ranking, and CCI-Q adaptation to link with ADL function. It was believed helpful for health care delivery to the disabled elderly. Here the study has presented some preliminary results of the reference, but still incapable of concluding rationally, universally, or conclusively. More furthermore studies are still mandatory