臺灣地區中老年人社會參與對有無喪偶者之存活分析與影響因素-
長期追蹤研究

目的：喪偶者有較高的死亡風險，但社會參與可能可以改變這樣的趨勢，本研究擬以長期追蹤趨勢研究資料庫進行分析，在控制相關影響因素下，探討社會參與情形對喪偶者之死亡影響，希望能改善喪偶帶來之不良健康結果。方法：本研究資料採用國健署與美國密西根大學人口暨老年學研究中心合作的「臺灣地區中老年身心社會生活狀況長期追蹤調查」資料 (Taiwan Longitudinal Study on Aging, 簡稱TLSA)，以1999年、2003年、2007年和2011年之連續四波的長期追蹤調查資料庫，研究對象為喪偶排除離婚與從未曾結婚者，喪偶者1,417人與有偶者4,500人，共計5,917人，持續追蹤至2012年12月31日，為期14年(自1999年波至2012年)期間之存活趨勢分析，並納入社會參與為主要影響因素進行分層比較分析。結果：結果顯示，喪偶者比非喪偶者年齡較高、女性較多、教育程度偏低、自覺健康較差、有較多慢性疾病、自覺經濟壓力較大、有規律運動的比例較低、有較多的日常生活活動功能(Activities of daily living, 簡稱ADL)障礙、簡易心智狀態問卷(The Short Portable Mental Status Questionnaire, 簡稱SPMSQ)的認知功能障礙較多、流行病學研究中心抑鬱量表(Center for Epidemiological Studies Depression, 簡稱CES-D)的憂鬱情形較多；喪偶者之死亡風險趨勢顯著的高於非喪偶者，有社會參與者之死亡趨勢顯著的低於無社會參與者。喪偶者經年齡及性別配對後，有社會參與者其死亡風險顯著降低調整後的風險比(HR)為0.83；95%信賴區間(CI)為0.71-0.98)。結論：喪偶無社會參與者死亡風險顯著高於喪偶有社會參與者，顯示出社會參與確實可降低喪偶者的死亡風險，因此針對喪偶者可將社會參與情形及類別納入健康提升計畫及社會福利的服務當中，如鼓勵年長者社會參與包括參與婦女會、宗教團體、公會、政黨、社會服務性社團、同鄉會及老人團體等皆有助益。

關鍵字

喪偶；社會參與；存活；死亡風險

並列摘要

Objectives：It has been considered that widowed persons have a higher risk of death. This study intended to explore whether social participation could improve this trend. A longitudinal study database was constructed to explore the trend of survival and its change with social participation in widowed persons. Methods：The Taiwan Longitudinal Study on Aging (TLSA), based on four consecutive waves of longitudinal follow-up data in 1999, 2003, 2007, and 2011 was linked with the National Death Registry from 1999 through 2012. In total, there were 1417 widowed persons and 4500nonwidowed persons included in this study, excluding divorced and never-married people. The survival trend analysis was carried out with social participation as the main predictive factor stratified for comparative analysis. Results：Our results showed that the widowed were older than the nonwidowed, were female-dominant, had a lower education level, were more economically stressed, and were less likely to engage inregular exercise, and thus showed generally poorer health; for example, being more vulnerable to having chronic diseases, disability with the Activities of Daily Living(ADL), cognitive impairment with the Short Portable Mental State Questionnaire (SPMSQ), and depression with. The Center for Epidemiological Studies-Depression (CES-D). The death risk of the widowed was significantly higher than that of the nonwidowed, but the death trend for those with social participation was significantly lower than that of their counterparts in both the widowed and nonwidowed. After matching with gender and age for widowed persons, the widowed with social participation had a significantly lower risk of death (adjusted hazard ratio(HR), 0.83; 95% confidence interval (CI), 0.71–0.98) compared to the widowed without social participation. Conclusions: It was concluded that social participation can improve the death risk for the widowed, and it is worthily included in health promotion plans and social welfare services for widowed persons.

並列關鍵字

widowed persons ； social participation ； survival ； mortality

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