臺灣老人失能趨勢之回顧

Review of Disability Trends among Older Adults in Taiwan

瞭解人口老化和失能（disability）盛行率趨勢（trends）有助於訂定長期照護政策。本文旨在回顧臺灣老人過去二十年失能盛行率趨勢，探討不同失能程度盛行率及影響因素，並提出臺灣資料庫建議。彙整盛行率方式係參考美國國家研究院老人失能調查資料庫準則，利用文獻回顧搜尋臺灣多個老人調查資料庫及研究。結果發現，臺灣老人在相對輕度的失能項目，包括：Nagi 功能限制和工具性日常生活功能（instrumental activities of daily living, IADL）失能的盛行率雖在不同資料庫結果不一致，但部分研究顯示失能盛行率已出現下降趨勢；在相對嚴重的失能項目，包括：日常生活功能（activities of daily living, ADL）失能的盛行率趨勢則是一致上升。臺灣老人不同失能程度盛行率差異可能和全民健保施行、外籍看護工居家照顧、基礎建設和科技進步等因素有關。最後，針對臺灣老人失能調查資料庫建議，包括建立國內老人功能和健康調查的設計共識指標、不同失能程度宜分開調查、致力於促進健康或環境改善等積極降低老人失能的具體措施。

Understanding ageing and disability trends in older adults is important for long-term care policymaking. This study aims to review the disability trends of the past two decades among older Taiwanese adults and examines factors that may influence these trends. Referencing criteria used to qualify disability surveys of older adults that were conducted by the US National Research Council, we estimated the disability trends of older Taiwanese adults in several Taiwanese ageing surveys. The results showed that mild to moderate types of disability trends, such as Nagi’s functional limitation and instrumental activities of daily living (IADL), were mixed and exhibited declining prevalence; however, severe types of disability trends such as activities of daily living (ADL) consistently increased in Taiwan within the reviewed years. Potential explanations for the development of different disability trends may result from universal health insurance benefits, the introduction of foreign caregivers, and infrastructure and technological improvements. Other recommendations for improving the quality of ageing and disability surveys in Taiwan are as follows: establish a consensus regarding the assessment of functional and health indicators in older adults, evaluate functional limitation and disability separately, and devote efforts to prevent disability in older adults (e.g. promotion of health and environmental modifications).