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  • 學位論文

家庭變故對中老年人健康軌跡之影響:成長模型之應用

The Influence of Family Hardship on Health Trajectory among Middle-aged and Elderly in Taiwan: An Application of Hierarchical Growth Modeling

指導教授 : 陳端容

摘要


研究背景:臺灣老年人口比例上升,並即將進入高齡社會。社會強調家庭價值,家庭除了是社會組成的重要元素,亦是中老年人情感與經濟的來源基礎,為老年人提供照護的功能、支持個人生活,並提供社會支持,過去研究發現自身及家庭成員經歷的事件都會影響中老年人健康。然而,過去對於中老年人健康狀況的縱貫性研究聚焦在追蹤時間結束當下之健康結果,較少探討健康隨著時間增加的改變狀況。本研究之目的在於瞭解中年人及老年人之自評健康及因健康而影響生活變化軌跡樣貌;重大家庭變故對中老年人自評健康及因健康問題而影響生活軌跡的影響,及其中之年齡及性別差異。 研究方法:本研究藉由分析「華人家庭動態資料庫」(Panel Study of Family Dynamics, PSFD)2005年至2014年之追蹤資料,以階層線性迴歸模型(Hierarchical Linear Model, HLM)之成長模型(Growth Model)分析臺灣中老年人經歷重大家庭變故與其健康狀況的關係。研究樣本之排除條件為2005年未滿40歲、2005年沒有任何家庭成員者、以及時間點資料少於三個,納入研究的樣本共1955位。 研究結果:本研究結果發現臺灣中老年人之自評不健康與時間呈線性成長關係;只有2005年時為65歲或以上受訪者有因健康問題而影響生活的機率會隨時間增加。經濟自主狀況、家庭關係品質、喪偶狀況及父母過世狀況是影響個體自評健康的重大家庭變故,這樣的結果有年齡及性別差異。個體因健康問題而影響生活的狀況會受經濟自主能力及家庭關係品質影響,同樣有年齡及性別差異。 結論:影響個體自評不健康與因健康問題而影響生活的因素不同,當中亦有性別及年齡差異,在執行介入時應考慮不同性別及年齡個體的需求。

並列摘要


Background: Studies have shown that difficult life events in family have adverse impact on family members. However, most studies focused on a particular health outcome at a certain point of time, usually the endpoint of a follow-up period. This study aims to understand 1) the trajectories of self-rated health and health problems change from 2005 to 2014 in a sample of middle-aged and elderly subjects in Taiwan, 2) the impact of family hardships on the trajectories of self-rated health and health problems change, and whether there is age and gender-specific pattern of health change trajectories. Method: The study analyzes the data of Panel Study of Family Dynamics (PSFD) from 2005 to 2014. Multilevel growth models were conducted. Subjects aged above 40, have at least one family member in 2005, and has at least three time points of data were included in the study. A total of 1955 subjects were included. Result: Results indicated that, for all subjects, self-rated health deteriorated as time went by from 2005 to 2014. However, only for subjects who were aged 65 or above in 2005, health problems became worse as time went by from 2005 to 2014. Low quality of family relationship, widowhood and parental loss are the factors that predicted the poor health trajectory. For men, widowhood and parental loss are crucial predictors, yet poor quality of family relationship can predict poor health trajectory for women. Conclusion: The results suggest that poor health trajectories is associated with family hardships, and there are age and gender differences. We should be aware of the differences when implementing interventions, in order to fulfill different needs of different individuals.

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