| Summary: | 碩士 === 國立陽明大學 === 衛生福利研究所 === 104 === Background: Patients with dementia in the early stage of disease still have self-care ability, but they become totally disable and have aggressive behavior in the later period, making it more difficult to take care of them. Several Studies found that there are differences on quality of care between people with and without dementia. However, in Taiwan there has not been a national population-based study identifying whether the quality of care is different between people with and without dementia in home and institutional care.
Objectives: To explore the effect of dementia on quality of care in home and institutional health care.
Methods: The study adopted a retrospective cohort study design, data were derived from the National Health Insurance Research Database, and the subjects were elders who use National Health Insurance Home Health Care at the first time during 2008-2012. Patients were divided into two groups－dementia and non-dementia group by using propensity score with sex, age and comobidity to match subject in each care site. Each case was monitored from the patient’ s entry day until the respiratory tract infection, urinary tract infection, pressure ulcer, fracture and hip fracture occurred or to the end of one year follow-up. Stepwise Cox proportional-
hazards regression was used to analyze the outcome, after controlling demographic, disease and institutional characteristics.
Results: In home health care, dementia group have higher respiratory tract infection risk(AHR=1.11)and pressure ulcer risk(AHR=1.43)than non-dementia group, however there were no difference in urinary tract infection, fracture and hip fracture between two groups during one year after they use services.
Conclusions: Dementia patients have higher risks in respiratory tract infection and pressure ulcer than people without dementia in home health care site. Medical institutions should keep going continuous education courses and monitoring the quality of care in institutional setting and enhance the caring skill of informal caregiver. Formal caregiver should strengthen the skill of dementia care, pass the long-term care information to patients who need it, and teach informal caregiver the skill of caring dementia patients.
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