臺灣中高齡民眾的老化態度與身心健康及活動參與的關係

背景與目的：隨著國民平均壽命的延長，能有效的幫助民眾維持/促進健康和預防/延緩失能是很重要的。文獻發現個人是否會採行健康生活型態跟他的老化態度有關。然而針對台灣中老年民眾的老化態度與其身心健康及活動參與的相關研究仍不多。故本研究針對台灣中高齡民眾對老的態度與其身心健康及活動參與的關係進行初探。特定目的有：(1)驗證一個用於台灣中高齡民眾的老化態度量表的建構效度及內部一致性，(2)探討中高齡民眾的老化態度與健康指標與活動參與的關係─針對全體及負面老化態度的民眾分別進行分析。方法：使用衛生福利部國民健康署「民國 100 年中老年身心社會生活狀況長期追蹤調查問卷」(TLSA 2011)資料庫，針對老化態度題目(老年心境11題)無遺失者，進行二次分析之研究(Secondary analysis)。(1)針對老化態度量表進行因素分析，內部一致性以克隆巴赫係數(Cronbach )的檢驗。與各類身心健康指標的關係以獨立t檢定及單因子變異量分析方式檢定。(2)探討老化態度與各類健康與活動參與的關係時，先將反向題重編碼再計總分，分數越高表示越正面。針對各類身心健康指標及活動分別與老化態度進行雙因子分析，兩組或三組間平均值的比較分別以獨立t檢定及單因子變異量分析進行比較，呈現組間顯著差異的變數，再計算效果量及進入階層式邏輯斯迴歸分析。(3)針對負面老化態度的族群(老化態度量表得分低於中位數，41分)，透過卡方檢定及獨立t檢定分析該人群的活動參與狀況是否跟健康指標及生活滿意度有關。結果：研究對象共3272人(佔TLSA2011資料庫的87.8%)。(1)因素分析的結果呈現TLSA 2011的老化態度題目涵蓋兩個因素(正面態度與負面態度)，各因素具有不錯的內部一致性(Cronbach ：正面＝0.75、負面=0.77)，且與健康狀態指標及功能性指標皆有顯著的關係，也就是健康好的人正面心態得分較高而負面心態得分較低，反之亦然。(2)從階層式邏輯斯迴歸分析結果得知，在社會人口學及健康指標變數已解釋的變異量以外，六項休閒活動仍可解釋顯著的變異量。從模型2的結果中得知，共有14項變數對於老化態度有一定程度的解釋能力。使用該量表所測得之老化態度與特定的健康指標以及活動參與有顯著的關係。(3)在負面老化態度之族群中，參與以下7類活動(看書報雜誌、與親朋好友聊天、與鄰居見面聊天、園藝、散步、騎腳踏車、戶外健身活動)者的身心健康指標及生活滿意度比不參加者明顯的好，但其效果量皆在小或非常小的程度。結論：(1)本研究結果支持TLSA 2011的老化態度題目(老年心境11題)的建構效度及內部一致性。(2)使用此量表所得之資料，與過去研究可以得到老化態度與健康以及活動間相似的關係，意即健康較佳或參與活動者的老化態度較正面。階層式邏輯斯迴歸分析發現對於老化態度而言，年齡增長、Mobility失能、IADL失能、ADL失能、有憂鬱、罹患心臟病及關節炎，上述的7類變數是老化態度的危險因子(Odds Ratio>1)；相對地，我們也能發現，有伴侶在身邊、有參加被挑選出來的6種活動，上述的7類變數則是老化態度的保護因子(Odds Ratio<1)。在控制了人口學及健康變數後，6項休閒活動仍可解釋顯著的變異量。(3)在負面老化態度的族群中，特定的7種活動或許有益於身心健康及生活滿意度。

關鍵字

老化態度；身心健康；身體活動；運動； TLSA2011

並列摘要

Background and purpose: As people live longer, it is crucial for the government to provide effective interventions to help people to maintain / promote their health and prevent / delay disability. According to the literature, whether an individual would adopt a healthy lifestyle is related to one’s attitude toward aging (ATA). However, the association of ATA with physical and mental health and activity participation is rarely investigated in Taiwanese population. Therefore, the purpose of this pilot study was to explore the association of health indicators and physical activies with the ATA in Taiwanese middle to old aged population. The specific aims were (1) to examine the construct validity and internal consisyency of an ATA questionnaire used in Taiwanese middle to old-aged population, and (2) to explore the relationship of ATA questionnaire with health indicators and activities participation – separate analysis for the whole population and those with negative ATA. Methods: This study was done by seconday analysis of the data collected in the " Taiwan Longitudinal Study in Aging 2011" (TLSA 2011). Aim to (1) the construct validity and internal consistency of the ATA questionnaire were examined by factor analysis and Cronbach . The relationships between ATA questionnaire and the various physical health indicators were examined by independent t test and one-way ANOVA. (2) Hierarchical logistic regression analysis was used to explore the factors significantly associated with ATA. ATA was the dependent variable. Negatively stated ATA items were first recoded, so that higher score indicates positive attitude. Then the total score of ATA was summed up and dichomotized by its median (41 points),  41 named positive attitude group and < 41 named negative attitude group. The demographic characteristics and health indicators were entered in block 1, and physical activities (exercise and leisure activities) were entered in block 2. (3) Finally, we focused on the group with negative ATA (the ATA score is lower than the median, 41 points), using the chi-square test and independent t-test to analyze whether the people’s participation in activities is related to health indicators and quality of life. Results: The data of 3272 respondents (87.8% of the total respondents in TLSA 2011) without missing value in ATA questionnaire were used in this study. (1) The results of factor analysis revealed that the ATA questionnaire used in TLSA 2011 consisted of two factors (positive attitude and negative attitude) and each with with acceptable internal consisitency (Cronbach  for positive and negative is 0.75, 0.77, respectively). People with better health or participating physical activities showed significantly higher positive attitude and lower negative attitude scores compared to those with worse health or not participating activities, and vice versa. (2) The results of hierarchical logistic regression demonstrated that six leisure activities still explained significant amount of variance over and above the other demographic and health indicators already in the regression. In model 2, there were 14 variables were significantly associated with ATA. (3) Among people with negative ATA (ATA score < median, 41 points), those who participanted the following 7 physical activities (reading, chatting with relatives and friends or neighbors, gardening, walking, bike riding, outdoor fitness activities) showed significantly better physical health, mental health and the quality of life than those who did not participated. Conclusion: (1) The results of this study supported the construct validity and internal consistency of ATA questionnaire in the TLSA 2011. (2) Consistent with previous studies, this study also found that the ATA questionnaire in the TLSA 2011 was significantly associated with health indicators and physical activities participation. People with better health or participantion of physical activities showed significantly higher positive ATA and lower negative ATA. The protective factors were living with partner and participation of 6 leisure activities. The Risk factors were advanced age, mobility disability, IADL disability, ADL disability, depression, and with heart disease and arthritis. Six leisure activities explained additional significant variance over and above the other factors already in the regression. (3) For elderly people with a negative ATA, the identified 7 activities might be beneficial to their physical and mental health and life satisfaction.

並列關鍵字

attitude toward aging ； physical and mental health ； physical activity ； exercise ； TLSA2011

參考文獻

內政部統計年報（民110）[資料檔]。台北市：中華民國內政部統計處。取自：https://statis.moi.gov.tw/micst/stmain.jsp?sys=220 ym=10905 ymt=11005 kind=21 type=1 funid=c0110201 cycle=41 outmode=0 compmode=0 outkind=1 fldlst=1111 cod00=1 rdm=qrxw4Aik