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  • 學位論文

對老的刻板印象、老化自我覺知及最適老化

Age Stereotypes, Aging Self-Perceptions, and Optimal Aging

指導教授 : 陳慶餘 陳淑惠

摘要


台灣已於2007年正式進入高齡化社會。為了解台灣目前所面臨的老化問題,筆者整理過去數十年來有關「好」的老化之研究後,認為應使用同時考慮「基本功能」與「個人適應」兩大面向之「最適老化」來定義「好」的老化較為適當。筆者等人以具台灣全國樣本代表性之2003年「台灣地區中老年身心社會與生活狀況長期追蹤調查(TLSA)」資料進行的「最適老化—基本功能」研究,說明以功能的角度來看時,目前台灣老年人的老化狀況;並指出當老年人有較為良好的「基本功能」時,會使個人有較高的可能性去「適應」老化。為進一步了解有那些心理、社會因素會影響個人的老化,回顧過去與老化相關之理論、研究後,筆者認為個人對「老」的態度可能是一個影響老化歷程的重要心理因素,個人從年輕時對「老」的刻板印象,與自己年紀較長時對自己的「老化自我覺知」,均可能會對一個人的老化歷程、老後的健康、以及存活有影響。 本論文之研究一:「對老之自我覺知對台灣老年人的功能性健康與存活之影響」,利用「台灣地區中老年身心社會與生活狀況長期追蹤調查」1989年至2003年的五波追蹤資料,以及2004年的存活資料,探討對台灣老年人來說,對老的自我覺知是否對個人的功能性健康、主觀生活狀態、基本功能狀態、及存活產生影響。用「覺得人老了有好處」與「覺得人老了有壞處」兩個變項來定義「對老之自我覺知」後,以1)混合設計ANCOVA來分析「對老之自我覺知」對14年間功能性健康狀態與主觀生活狀態變化的影響;2)序列式邏輯式迴歸分析探討對14年後「基本功能狀態」之影響;3)以存活分析探討對15年後存活情形的影響。結果發現認為老了以後「只有壞處、沒有好處」者之後續狀態最差,其推估存活時間較短、15年後死亡風險較高、14年後之基本功能狀態較差的機率高、功能退化較早或退化趨勢較快、功能表現較差、及主觀生活狀態較差。認為老了以後「好、壞處兩者都有」者之後續狀態則相對較佳。研究一結果支持以「正向」、「負向」兩個向度來討論「對老之自我覺知」較為適當。 本論文之研究二:「對老的刻板印象、老化自我覺知、最適老化目標、及老年健康狀態」,則欲進一步探討「對老的刻板印象」如何成為個人的「老化自我覺知」,以及對健康的影響。筆者提出一「老化態度與最適老化」概念模式,認為個人由「尚未老」進入「老」的「老化過渡期」中,會試圖去因應「變老」一事,在某些面向上選擇接受自己開始變老,但另一些面向上則強調自己並沒有老。而「老化自我覺知」的形成亦同,會接受、內化某些老年刻板印象,但會試圖去因應、對抗另一些刻板印象。第一部份設計「最適老化目標」、「對老的刻板印象」、及「老化自我覺知」等三個量表,並初步檢驗其心理計量特性。第二部份探討「最適老化目標」、「對老的刻板印象」、「老化自我覺知」及「老年健康狀態」的關係。此部份研究以74位加入「老年周全性評估照護研究」之65歲以上台灣人為對象,依「老化態度與最適老化」概念模式,針對進入「老化過渡期」後的假設進行探索。結果發現1)老化經驗會對個人「對老的刻板印象」形成「老化自我覺知」的歷程造成影響;2)個人會藉由「老化自我覺知」與「對老的刻板印象」讓自我與他人有區隔,以作為一種對自己變老的「因應」;3)「負向老化自我覺知」與老年人的功能性健康有顯著相關,而「對老的負向刻板印象」需經由「負向老化自我覺知」才對功能性健康造成影響;4)「正向老化自我覺知」較佳之老年人,有較好的「心理」與「社會」上的生活品質。 本論文之結果支持「對老的態度」對台灣老年人的健康與存活有影響,且老年人會試圖因應自己所面對的「老化」現象。由本論文結果可推論,臨床心理師在協助老年人最適老化的過程中應扮演相當重要的角色,一方面可以協助個人去理解自己所面對的老化現象為何,並選擇恰當的最適老化目標;另一方面則可藉由改善個人對自己正、負向的老化自我覺知,來試圖平衡從年輕時即累積的對「老」的刻板印象,以協助個人能在老化過程中維持較好的情緒狀態與生活品質,以繼續因應隨老化而來的改變。

並列摘要


Many studies had found that “age stereotypes” and “aging self-perceptions” held by the person might affects his/her own health, survival, and optimal aging when he/she grows old. The aim of the study 1 of this thesis was to examine if “aging self- perception” affects longitudinal functional health and survival in Taiwanese older adults. Participants in study 1 included 3793 people (aged 60+) from a national representative database, the Taiwan Longitudinal Study of Aging (TLSA). TLSA began in 1989, and followed-up in 1993, 1996, 1999, and 2003. The aging self-perception were defined by 2 questions: “In your experiences, do you think it is 1)advantageous (yes/no), 2)disadvantageous (yes/no) when people get old?” asked in 1989, and were used to predict 1) functional health and subjective well-being during the 14 years period by analysis of covariance method; 2) basic functional health status of optimal aging in 2003 by ordinal logistic regression; and 3) survival status in 2004. For those people who reported “only disadvantages, no advantage”, the results showed that they had higher dying risk, shorter survival time, higher possibility to be categorized in poorer function status group 14years after, earlier and/or faster functional decline, poorer functional health and subjective well-being. On the contrary, those people who reported “both advantages and disadvantages” had the better results on functional health, subjective well-beings and survival. The study 2 of this thesis was aim to explore the relations among age stereotypes, aging self-perceptions, goals of optimal aging, and health in older adults. The author proposed an “attitude toward aging and optimal aging” concept model, which hypothesized that while people growing old, they will try to cope with “aging”. One of the coping strategies was to modify one’s “age stereotypes” and “self- perceptions”, to reject those stereotypes and self-perception that related with one’s important aging goals, but to accept those that were not related. Participants of study 2 included 74 Taiwanese older adults (65+) from a clinical geriatric study. Three scales, the “goals of optimal aging” scale, the “age stereotype” scale, and the “aging self- perception” scale, were established first. Then participants were asked to fill these 3 scales, and other health related data (e.g. frailty, walking speed, ADL, etc.) were collected by research nurses. The results showed: 1) people in different health status had different patterns of paths linking “age stereotype” to “aging self-perceptions”; 2) people could modify one’s “age stereotypes” and “aging self-perceptions” to distinguish oneself from other old people; 3) “Negative Self-Perception of Aging (NSPA)” were significantly correlated with functional health, those who reported higher NSPA walk slower, reported poorer functional health, and less active; 4) “age stereotypes” did not had significant direct paths to link to functional health, but to link indirectly via NSPA; 5) those reported higher “positive self-perception of aging” had better quality of life on psychological and sociological domains. The results of the thesis supported that “attitude toward aged and aging” did affect functional health and survival in Taiwanese older adults, and people will try to cope with “aging” while they grow old. These results might imply that clinical psychologist could play a crucial part in helping people to cope with their aging process. Clinical psychologist could help them to understand what they are facing, to choose proper optimal aging goals, and to modify one’s aging self perceptions in order to counter the effects of negative age stereotypes.

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