資產效果對於老年時期生活品質的影響-生命歷程觀點的分析

asset effect for quality of life in later life -a life course analysis

陳君儀(Chun-Yi Chen)

指導教授 ： 鄭麗珍

國立臺灣大學/社會科學院/社會工作學研究所/博士(2014年)

https://doi.org/10.6342/NTU.2014.01848

摘要

由於醫療科技的發展以及經濟、社會各項條件的改善，個人的平均餘命呈現上升軌跡；相對的，整體生育率卻顯示持續下滑的現象，凸顯出人口結構老化的發展趨勢。世界衛生組織（WHO，2002）的人口統計與成長預估數據顯示，60歲以上老年人口自1970年至2025年的成長率約達223％，估計60歲以上的人口數到了2050年時將上升至20億人，屆時65歲以上的老年人口將占總人口數的16.2%。在人口結構改變的脈絡中同時也可能形成世代接替的斷層，並且對於社會支撐力和長期照顧需求帶來挑戰。依據生命歷程的觀點，老年階段一方面反映出各個發展時期的經驗累積結果，另一方面也受到各項生命轉折關鍵時機與歷史脈絡的影響，進而形塑個人的生活調適能力與生活品質狀態。因此，由於整體人口結構高齡化的趨勢，老年階段將成為普遍的生命經驗，一方面由於延長的老年生活階段，使個人經驗到更長期的老化與衰弱歷程，也因此延長了個人與失能和疾病共存的時間。另一方面，依據職場輪替與社會退位的年齡規範，老年階段的重大生活轉折之一，即是逐步退出有給勞動市場，以及進行家庭內的資產移轉。相對的，隨著老年時期的延長，意味個人中斷穩定收入時間的延長，導致老年階段將面臨持續衰弱、資產遞減、社會撤退等風險。資產效果理論主張，各種有形無形的資產形式將能夠產生包含經濟、心理及政治社會等三個層面的正向促進效果。換句話說，由於長時期資產的持有與累積，使個人能夠產生因應經濟、健康與老化等風險的能力。本研究即依據資產效果理論，探討個人的資產累積狀態以及生命歷程中相關因素，能否對於經歷各式老化風險的老年生活品質，產生正向促進的影響效果。
本研究聚焦老年時期的發展經驗與生命歷程的累積結果，同時探討老年生活的現況，並且追溯生命發展歷程中各項老年生活品質的影響因素，進而，分析資產效果在多元影響因素中對於老年生活品質的影響。為針對老年生活發展進行貫時性研究，本研究運用次級資料分析法，採用衛生福利部健康資料加值應用協作中心-健康資料檔之「中老年調查檔」的長期追蹤樣本，作為研究分析對象，探討相關因素與資產效果對於老年時期生活品質的影響。因此，研究針對各波段調查中的個人生活品質、健康狀態、資產狀態，以及個人社會人口學基本資料等進行分析。在資料分析方法部分，運用次數分配、皮爾森積差相關、變異數分析、雙因子潛在特質變化分析、結構方程式分析模型等分析步驟，逐項探討老年時期生活品質狀態、影響老年生活品的相關因素，以及資產效果對於老年時期生活品質的影響力。
研究結果顯示，在不同發展階段中普遍反映出良好生活品質的特質依序包含，早年生活經驗中較高的父親教育程度，以及較佳的成長過程家庭經濟狀況；在成年發展過程中，維持日常生活功能不惡化者、維持慢性疾病數量不增加者；在老年階段，身心理各方面較佳的健康狀態、資產收入金額愈高者、社會網絡愈大者；再加上能夠及早為老年生活儲蓄者，以及男性、教育程度較高等個人特質條件者。進而，在成年中晚期的生活品質發展方面，在各個面向中，主觀生活滿意度與社會參與程度呈現向上提升的趨勢，而自我感受能力以及主觀健康評估則是在曲線波動後，呈現相對大幅下滑的發展軌跡。並且在主觀生活品質與社會參與的正向發展軌跡中，早先的狀態均會顯著的影響該項生活品質狀態在進入老年階段時，後續之持續改變的幅度與速率。
另一方面，個人在發展過程中的特質條件，與其生活品質發展軌跡的共變關係中顯示，包含個人健康狀態、有形與無形資產條件等特質，均與成年中晚期發展階段初始的生活品質狀態顯著相關，諸如較良好的健康狀態、較佳的資產條件水準，均能夠促進個人良好的生活品質基礎；然而，隨著年齡的增長，持續顯著影響生活品質的條件僅剩下慢性疾病的數量，顯示隨年齡而增加的慢性疾病，顯著的成為個人進入老年階段生活品質的主要影響因素，相對的，能夠帶來正向提升效果的資產條件，則可能由於隨年齡增長而發生累積停滯的現象，而在持續高齡化的過程中，弱化的其可能帶來的正向影響效果。
整體而言，在個人的發展歷程中，個人的資產條件持續相互的影響與累積，進而形成個人在老年生活品質的重要影響因素，並且能夠在健康條件持續具有影響力的老年發展階段，同樣發揮顯著的影響效果；在其中，個人的無形資產之影響力大於有形資產對於生活品質的影響。因此，在高齡化的社會發展趨勢中，要能夠達到老年生活品質持續正向發展的目標，以落實健康的老年生活、持續社會參與、創造社會與經濟發展的活躍老化社會，可從老年經濟安全制度，以及與健康和諧共存等二個層面著手，前者，以實施足以維繫基本生活條件以上之經濟安全制度為基礎，同時發展以政策引導的資產累積之個人儲蓄方案，以及再造與活化個人的非正式社會支持網絡，目的是促進個人所持有的資產，能夠在持續老化的過程中，穩定發揮提升良好生活品質的資產效果；另一方面，為了因應老年發展歷程中普遍惡化的健康發展趨勢，則必須同步採取包含維護健康服務使用權利、健康行為促進、創造有形與無形之無障礙環境等策略，協助個人發展與不健康風險和諧共存的能力。

關鍵字

資產效果 ； 生活品質 ； 活躍老化 ； 生命歷程取向 ； 貫時性研究

並列摘要

Abstract
With improvements in medical technology and socioeconomic conditions, the average remaining lifetime is increasing. However, the continuing decrease in birth rate indicates an ageing population. According to forecasts by the World Health Organization (WHO 2002), the growth rate of the older population from 1970 to 2025 is estimated to be 223%, with some 2 billion people over the age of 60 by 2050, and people above the age of 65 will make up 16.2% of the entire population. This population structure change could also mean a generational fraction, and bring about challenges to the society’s supporting capacity and the need for long term elderly care. From the life course perspective, old age is not only a culmination of experiences from different development stages but also whose adaptedness to and quality of life have come under the influence of various turning points in life. Therefore, with the inevitable trend of an ageing population, old age will become a common experience. On one hand, the prolonged life extends the ageing and weakening process, resulting in a longer period of coexisting with personal loss of faculty and diseases. On the other hand, labor market disengagement and the transfer of family asset mark an important transition to old age. The extension of old age means the period without a stable income is prolonged, thus exposing one to several risks. The theory of asset effect suggests that all tangible and intangible assets can exert positive effects in economic, psychological and sociopolitical levels. In other words, long term possession and accumulation of assets can spur capabilities in response to economic, health and ageing risks. This study discusses, from the such theoretical perspective, if personal asset accumulation and related factors in life course can bring about positive effects to the quality of life in an old age that is prone to various ageing risks.
This study focuses on the developmental experience in old age and the accumulation of life course. At the same time, it discusses the life status in old age and traces back to the factors of various life stages to analyze the asset effect to the quality of life in old age. Secondary data analysis is used in this longitudinal research, with long term follow-up samples of the middle-aged and the elderly from the value-added application platform by the Ministry of Health and Welfare. The study analyzes personal quality of life, health and asset status of various ranges, and basic social demographic data. Frequency distribution, Pearson’s correlation, t-test, one way ANOVA, latent growth models and structural equation model are employed to measure the quality of life, affecting factors and asset effects in old age.
The results show that characteristics that reflect good quality of life at various developmental stages include: (1) in early life experience, having better educated father and better financed families; (2) in adulthood, sustaining a well-functioned everyday life functions, and having the number of chronic diseases under control; (3) in old age, having healthier physical and mental conditions, higher income, larger social network, being able to save up early for old age, and being males who received better education. Furthermore, with regard to the quality of life in the middle and later stage of adulthood, subjective satisfaction with life and social participation in all areas show an upward trend, with previous statuses affect significantly the extent and rate of the respective quality of life when it enters old age. Self perception and health assessment, on the other hand, show a relative downward fluctuation.
The covariance of the characteristics in personal development and the development of the quality of life shows that personal heath, asset conditions etc are relevant to a better starting point in quality of life in the middle and later stage of adulthood. However, as one turns older, the only condition that continue affects the quality of life is the number of chronic diseases. In contrast, the asset factor that brought about positive uplifting effect may become stagnant and its positive effects are being weakened in a continuing ageing process.
To sum up, in the course of life, the influence and accumulation of asset become important factor to the quality of life and continues to affect significantly even into the old age, with health as a persistent influence. The effect of intangible asset, in particular, is greater than that of the tangible with regard to quality of life. Thus, in the ageing society, the aim of a positive development in old age so as to implement a healthy old life, continued social participation, create socioeconomic development may be reached on two levels: senior financial security system and coexisting in harmony with personal health. The former is implemented on the basis of sustaining basic life needs and develop policy-mandated personal savings scheme and to re-create and re-invigorate informal social supporting network. The purpose is to enhance personal asset’s positive impact in a continuing ageing process. On the other hand, in response to the common problem of deteriorating health in old age, measures such as maintaining the rights to health services, promoting healthy behaviors and creating tangible or intangible barrier-free environment, must be implemented simultaneously to assist individuals in coping to live harmoniously with unhealthy risks.

Key Words: asset effect, quality of life, active aging, life course, longitudinal research

並列關鍵字

asset effect ； quality of life ； active aging ； life course ； longitudinal research

參考文獻

徐慧娟、吳淑瓊、江東亮（1996）跌倒對社區老人健康生活品質的影響，中華公共衛生雜誌，15（6）：525 -532 。

趙安娜、高美玲、林壽惠（2004）鄉村社區老年人健康狀況與生活品質相關性之探討，長期照護雜誌，8（1）：41 -55。

宋文娟、洪錦墩、陳文意（2008）台灣老年人口醫療利用與多重慢性疾病之分析研究，台灣老人保健學刊，4（2）：75-87。

黃鈺婷（2011）個人、家庭與學校脈絡中的影響變因與青少年身心健康發展軌跡之討論，中華輔導與諮商學報，29：161-181。

楊桂芬、許哲瀚、唐憶淨、龔建吉，2012）