目的：新型冠狀病毒肺炎(COVID-19)自2019年底爆發以來，疫情迅速蔓延至世界各地，最後演變成全球大流行，台灣醫療衛生體系與人民的日常生活及健康也深受疫情影響。近年來，許多研究紛紛指出老年病患對於急診醫療有著不同的需求與使用特性。然而，隨著疫情日益嚴峻，國內探討於COVID-19疫情下老年人急診醫療使用情形之研究相對有限。因此本研究欲探討於COVID-19疫情爆發前後20-64歲成年人與65歲以上老年人兩年齡組別急診病患之特徵與急診停留時間是否有差異，並探究急診停留時間超過24小時之影響因素，以瞭解急診病患醫療使用的改變情形及影響。
方法：本研究資料來源由南部某醫學中心提供，回溯收集2019年與2020年1月至9月兩區間內之急診病患。研究對象以年齡區分為兩組：65歲以上老年人與20-64歲成年人。統計方法包括描述性統計、皮爾森卡方檢定、獨立樣本t檢定、羅吉斯迴歸分析。
結果：本研究共有77,002人次於急診科就診，與20-64歲成年病患相比較，65歲以上老年病患較不受到COVID-19疫情影響而改變急診的使用。COVID-19疫情爆發後，老年病患的急診使用比率較高、檢傷分類級數較低(急迫性較高)、住院率較高、急診停留時間較長，影響老年病患急診停留時間超過24小時的顯著因素只有男性、75-84歲、內科系、外科系。
結論：COVID-19疫情所帶來的嚴峻威脅，確實改變了民眾的急診就醫行為，使整體急診就診率下降。儘管如此，本研究結果彰顯出老年病患急診醫療使用議題之重要性，隨著台灣邁入高齡社會，建議未來醫療院所藉由瞭解老年病患在急診室複雜且非特異性症狀，以提升台灣的急診醫療品質及病人安全。

Objectives: Since the end of 2019, COVID-19 has rapidly spread around the world and eventually caused a severe global pandemic. The outbreak has also affected Taiwan's medical and health system and people's health and lives. In recent years, many studies have pointed out that elderly patients have different needs and utilization characteristics for emergency medical services. However, with the changes of COVID-19 pandemic, there are limited studies on COVID-19 to investigate emergency medical services used by elderly in Taiwan. The aim of the study is to explore the difference of characteristics and length of stay (LOS) of emergency department (ED) patients before and after the COVID-19 outbreak and to understand the impact of medical utilization caused by the COVID-19 outbreak.
Methods: In this study, data from a Medical Center in Southern Taiwan were retrospectively collected emergency department patients in the interval between January and September 2019 and 2020. These subjects were divided into two groups by age: the elderly group aged over 65 and adults aged 20 to 64. Data analysis methods included descriptive statistics, Pearson's chi-square test, independent sample t-test, and binary logistic regression.
Results: The study found that there were 77,002 visits to the emergency department. Compared with young patients, elderly patients were less affected by the COVID-19 pandemic and changed their emergency medical utilization. After the outbreak of the COVID-19 pandemic, elderly emergency patients had a higher rate of emergency use, higher triage levels, higher hospitalization rates and stay longer at emergency department. The elderly patients those were male, aged 75-84, internal medicine, surgery had a higher odds ratio for ED LOS over 24 hours.
Conclusion: The severe threat of the COVID-19 epidemic has indeed changed the behavior of people in ED visits and reduced the overall ED visit rates. Nevertheless, the results of this study emphasize the importance of the issue of medical utilization of elderly ED patients. With Taiwan’s rapidly aging society, it is recommended that medical institutions in the future improve the medical quality and patient safety by understanding the complex and non-specific symptoms of elderly patients in the emergency room.

論文審定書 ⅰ
中文摘要 ⅱ
Abstract ⅲ
目錄 ⅴ
圖次 ⅶ
表次 ⅷ
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 研究流程 3
第二章 文獻探討 5
第一節 COVID-19概況 5
第二節 急診醫療服務 8
第三節 疾病爆發之急診資源利用 13
第四節 老人急診資源利用 17
第五節 文獻探討小結 19
第三章 研究方法 20
第一節 研究設計與架構 20
第二節 研究假說 22
第三節 資料來源與研究對象 23
第四節 研究變項與操作型定義 25
第五節 研究資料處理與分析 32
第六節 研究倫理考量 33
第四章 研究結果 34
第一節 描述性統計分析 34
第二節 皮爾森卡方檢定 44
第三節 獨立樣本t檢定 51
第四節 羅吉斯迴歸分析 59
第五章 研究討論 67
第一節 研究結果討論 67
第二節 研究假說驗證 72
第六章 結論與建議 74
第一節 結論 74
第二節 研究限制 76
第三節 研究建議 77
參考文獻 79

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