探討台灣老年人社會支持對工具性日常生活功能之影響

Effectiveness of social support on the change of instrumental activities of daily living function among older adults in Taiwan

沈彥菱(Yen-Ling Shen)

指導教授 ： 喬佳宜 ； 廖玟君

中山醫學大學/醫學院/護理研究所/碩士(2014年)

https://doi.org/10.6834/CSMU.2014.00121

摘要

前言：隨著醫療服務的改善，壽命的延長，老化人口逐漸增加。雖然人口結構呈現高齡化，但老年人活得長壽，並不保證活得快樂，晚年生活品質亦不見得滿意。因此在人口老化現象日漸嚴重的背景之下，老年人健康相關之研究日漸受到重視。其中失能的產生，不僅加速老化的進展，影響生理和心理的變化，同時老年人生活品質亦相對的受影響。許多研究發現，老年人的社會支持，具有保護緩衝作用，可調節失能對身心狀況的損害。因此，本研究探討老年人社會支持對工具性日常活動功能之影響。
方法：本研究採用縱貫性長期追蹤研究設計，使用衛生福利部國民健康署『台灣地區中老年身心社會生活狀況長期追蹤調查』之1996年和1999年問卷調查資料，以60歲以上老年人為研究樣本。本研究之自變項為社會支持，包括得到性之情緒性與工具性社會支持、給予性之情緒性與工具性社會支持；依變項為工具性日常生活功能包括購物和使用電話；控制變項則為基本人口學特質(年齡、婚姻、同住狀態、教育)、生理(慢性疾病、身體活動功能)和心理(憂鬱、認知功能)相關因素。資料分析採用SPSS/PC 19.0版統計套裝軟體整理與分析，以描述性統計來分析變項基本特性及分佈情形，以卡方檢定檢測雙變項之關係並以邏輯斯迴歸控制所有相關因素後，檢視社會支持與工具性日常生活功能之關係。
結果：研究樣本數共1,880人，平均年齡為68.21歲(S.D. ± 6.0)，研究結果發現男性老年人之年齡(OR：1.86、95%C.I.：1.039-1.136)、教育程度(國中組OR：0.27、95%C.I.：0.119-0.614)、罹患慢性疾病(OR：4.54、95%C.I.：2.567-8.033)和得到工具性社會支持(OR：0.42、95%C.I.：0.215-0.825)及參與社團活動(OR：0.45、95%C.I.：0.256-0.795)對工具性日常生活功能功能影響有顯著意義；而女性老年人之年齡(OR：1.09、95%C.I.：1.050-1.132)、教育程度(國中組OR：0.091、95%C.I.：0.022-0.382)、罹患慢性疾病(OR：1.708、95%C.I.：1.050-2.779)對工具性日常生活功能功能影響有顯著意義。女性老年人之社會支持相關變項對IADL功能皆未具有顯著差異，此結果顯示與男性有非常大的差異。
結論：得到工具性社會支持和參與社團活動對男性老年人的IADL是具有保護的效果存在；但對女性而言，所有社會支持變項卻對IADL完全不具有顯著意義，突顯出老年人在性別的差異對社會支持也有不相同的結果表現。本研究結果可加強社區健康照護人員，推廣對老年人的社會支持，鼓勵家人傾聽並適時表達關心，以及提供老年人工具性之支持(如：生病時之照顧和關懷)，以減緩老化所產生之失能，進而促進老年人的生活品質並達到成功老化。

關鍵字

社會支持 ； 工具性日常活動功能 ； 老年人

並列摘要

Introduction：With improving medical services and extended life span, the older adult population has also increased. Although the older adults can live longer, it does not mean that they will live happier nor will be more satisfied with their quality of life. Therefore, more attention has been placed on the health related issues among older adults in Taiwan. Disability could speedy the process of aging, it could also influence physiological and psychological health as well as the quality of life among older adults. Previous studies confirmed that social support has a protective effect and can buffer damages brought from disabilities to prevent physical and mental illness among older adults. The aim of this study was to explore effects of social support on the change of instrumental activities of daily living function among older adults in Taiwan.
Methods：This study was based on a longitudinal study design. The study data obtained from the data bank of “Survey of Health and Living Status of the Middle Aged and Elderly in Taiwan”, which had been conducted in 1996 and 1999 by the Bureau of Health Promotion, Department of Health. The study population was 60 years old or more in Taiwan. The independent variable of this study was social support, which consisted of received instrumental social support, received emotional social support, provided instrumental social support, and provided emotional social support. The dependent variable was Instrumental Activities of Daily Living. The controlled variables were demographic characteristics, physical, and mental factors. Data was analyzed by using SPSS/PC 19.0 software package. Descriptive statistics, which included frequency distribution, percentages, means, and standard values of demographic characteristics were examined. Logistic regression analysis was conducted to measure inferential statistics.
Results：The total number of observations was 1,880.The average age of the study population was 68.21years. The results found that Instrumental Activities of Daily Living function was significantly influenced by age, educational levels, chronic diseases, received instrumental social support, and engagement membership for men. In addition, Instrumental Activities of Daily Living function was significantly influenced by age, educational level, and chronic diseases for women. However, no significant difference was found between social support variables and Instrumental Activities of Daily Living, which was inconsistent with the results for men.
Conclusions：The results of this study concluded that receiving instrumental social support and engagement in membership have protective effects on Instrumental Activities of Daily Living for elderly. But in females, all social support variables did not present significantly with Instrumental Activities of Daily Living. This study results can enhance social support and provide instrumental support for the elderly, in prolonging disability caused by aging, to promote a better quality of life and to achieve successful aging.

並列關鍵字

social support ； Instrumental Activities of Daily Living ； elderly

參考文獻

于漱、吳淑瓊、楊桂鳳 (2003)。失智症患者的長期照護服務模式。長期照護雜

吳淑瓊、徐慧娟、莊媖智、張明正 (1996)。功能評估在估計台灣社區老人長期 照護需要之應用。中華公共衛生雜誌，15 (6)，533-545。

鬱程度、社會支持與醫療服務使用之相關性。Chung Shan Medical Journal

陳施妮、孫嘉玲 (2008)。獨居老人健康、生活功能與跌倒概況分析。長期照護

陳惠真、王香蘋 (2005)。台灣老人健康狀況初探：1989年至1999年。臺灣