台灣老人自覺健康狀況之因素探討: 國家長期追蹤研究之結果分析

The Correlating Factors of Self-Rated Health among the Elderly in Taiwan: Results of the National Longitudinal Study

杜明燦(Ming-Tsan Tu)

指導教授 ： 李孟智 ； 顏啟華

中山醫學大學/醫學院/醫學研究所/碩士(2011年)

https://doi.org/10.6834/CSMU.2011.00090

摘要

目的： 老年化已是台灣及世界各國人口發展趨勢，台灣老年化人口成長比起其他國家更加顯著，因此對於老人的健康照護之研究更顯重要，而自覺健康狀況對於測量個人生理、心理與社會健康具有綜合性指標意義，本研究藉由國民健康局之「台灣中老年人身心社會狀況長期追蹤調查」第四波1999年及第五波2003年之問卷資料，以探討影響自覺健康狀況之因素，尤其是家庭內因素之探討。 方法： 研究以1999年第四波調查為基期，調查各項可能影響自覺健康狀況之因素，再進一步追蹤2003年第五波調查之自覺健康狀況，並探討各因素包括：教育、慢性疾病、日常生活功能(activities of daily living score)、工具性日常活動功能(instrumental activities of daily living score)、憂鬱症狀、認知功能、身體質量指數(body mass index)、中臂圍、小腿圍、休閒娛樂、社團活動參與、以及各項家庭內因素包括：婚姻狀況、居住穩定度、獨居、居住安排滿意度、與家人分享憂慮意願、家人關心程度、家人關心滿意度、經濟狀況困難度等因素，並以2003年自覺健康狀況為依變項，先以卡方檢定作為各項因子對於自覺健康狀況的單變項分析，再將卡方檢定有顯著意義之變項進行邏輯式回歸分析，探討各個因素對自覺健康狀況之相關性與預測能力。 結果： 經過四年的追蹤發現，小於六年的教育程度 小於六年的教育程度 小於六年的教育程度 小於六年的教育程度 (OR：0.690.690.690.69 [95.0% C95.0% C95.0% C 95.0% CI： 0.530.53 0.53-0.900.90 0.90]；p < 0.01)、大於十二年的教育程度 大於十二年的教育程度 大於十二年的教育程度 大於十二年的教育程度 (OR：0.430.430.430.43 [95.0% C.I.= 95.0% C.I.= 95.0% C.I.= 95.0% C.I.= 95.0% C.I.=0.210.21 0.21-0.860.86 0.86]；p = 0.020.02 0.02)、有一項慢性疾病(OR：2.102.102.102.10 [95.0% C95.0% C95.0% C 95.0% CI：1.411.41 1.41-3.133.13 ]；p < 0.01)、有兩項慢性疾病(OR：2.312.312.312.31 [95.0% C95.0% C95.0% C 95.0% CI：1.541.54 1.54-3.453.453.453.45]；p < 0.01)、有三項以上慢性疾病(OR：3.393.393.393.39 [95.0% C95.0% C95.0% C 95.0% C I：2.322.322.322.32-4.954.954.954.95]；p < 0.01)、日常生活功能(OR：2.062.062.062.06 [95.0% C95.0% C95.0% C95.0% C95.0% C95.0% C I：1.231.23 1.23-3.483.48 3.48]；p < 0.01)、工具性日常活動功能(OR：1.421.42 1.42 [95.0% C.I.= 1.1095.0% C.I.= 1.1095.0% C.I.= 1.1095.0% C.I.= 1.1095.0% C.I.= 1.1095.0% C.I.= 1.10 95.0% C.I.= 1.10 95.0% C.I.= 1.1095.0% C.I.= 1.10 95.0% C.I.= 1.10-1.821.82 1.82]；p < 0.01)、憂鬱症狀(OR：1.521.521.521.52 [95.0% C.I.= 1.1795.0% C.I.= 1.1795.0% C.I.= 1.1795.0% C.I.= 1.1795.0% C.I.= 1.1795.0% C.I.= 1.17 95.0% C.I.= 1.17 95.0% C.I.= 1.1795.0% C.I.= 1.1795.0% C.I.= 1.1795.0% C.I.= 1.17-1.991.991.991.99]；p < 0.01)等因素仍為有較差之自覺健康狀況的強烈預測因子，而在家庭內因素方面，居住穩定度以及經濟狀況滿意度在經過調整其他明顯因子之後，仍具有顯著相關性。而在性別分層分析發現，男性在於慢性疾病、工具性日常活動功能、居住穩定度以及經濟狀況滿意度等因子皆呈現與自覺健康狀況相關。女性則是在於慢性疾病、日常生活功能、憂鬱症狀、休閒娛樂等因子具有相關性。 結論： 慢性疾病、日常生活功能、工具性日常活動功能、憂鬱症狀等因子仍為自覺健康狀況的強烈影響及預測因子，而在家庭內因素方面，居住穩定度以及經濟狀況滿意度為自覺健康狀況顯著且獨立的預測因子。

關鍵字

自覺健康狀況 ； 老人 ； 預測因子 ； 長期追蹤 ； 台灣

並列摘要

Objective：
Aging is a global trend, and Taiwan is one of the fastest aging nations. Among the elderly, self-rated health status has proven to be a marker for each individual’s physical and psychological health and society’s health in general. This study aims to explore the factors influencing elderly’s self-rated health status, emphasizing on intrafamilial factors, from a longitudinal study of “Survey of Health and Living Status of the Elderly in Taiwan”, during a four year period (1999-2003).
Methods：
Data were derived from a population based cohort study of 1646 elderly Taiwanese that were collected in 1999 and 2003. Self-rated health status, and factors possibly associated to it were used for analyses. These factors included educational level, chronic diseases, activities of daily living score, instrumental ADL, depressive symptoms, cognitive function, body mass index, mid-forearm circumference, calf circumference, leisure/entertainment, social participation, intrafamilial factors (marriage status, living arrangement stability, living alone, satisfaction regarding living arrangement, willingness share worries to family, degree of family’s care, satisfaction to family’s care, financial status). The above factors were set as independent variables and the 2003 self-rated health status as the dependent variable; subsequently analyzed using analyzed with Chi-square test. Using stratum logistic regression, six models were established with the significant variables (by chi-square) including (1) educational level (2) chronic disease number (3) activities of daily living (4) instrumental activities of daily living (5) depressive symptoms (6) intrafamilial factors and odds ratio (OR) and the 95％ confidence interval(CI) were calculated.
Results：
The factors associated significantly with self-rated health status were under 6 years of formal education (OR：0.690.690.690.69 [95.0% C95.0% C95.0% C 95.0% CI：0.530.530.530.53-0.900.90 0.90]；p < 0.01)、above 12 years of formal education(OR：0.430.430.430.43 [95.0% 95.0% 95.0% CI：0.210.210.210.21-0.860.860.860.86]；p = 0.020.020.020.02)、having one chronic disease(OR：2.102.102.102.10 [95.0% C95.0% C95.0% C 95.0% CI：1.411.41 -3.133.13 3.13]；p < 0.01)、having two chronic diseases(OR：2.312.312.312.31 [95.0% C95.0% C95.0% C 95.0% CI：1.541.541.541.54-3.453.453.453.45]；p < 0.01)、having three or more chronic diseases(OR：3.393.393.393.39 [95.0% C95.0% C95.0% C 95.0% C95.0% C I： 2.322.32 2.32-4.954.95 4.95]；p < 0.01)、activities of daily living(OR：2.062.06 2.06 [95.0% C95.0% C95.0% C95.0% C95.0% C95.0% C I： 1.231.23 1.23-3.483.48 3.48]；p < 0.01)、instrumental activities of daily living(OR：1.421.421.421.42 [95.0% 95.0% 95.0% 95.0% CI：1.101.101.101.10-1.821.821.821.82]；p < 0.01)、depressive symptoms(OR：1.521.521.521.52 [95.0% C95.0% C95.0% C95.0% C95.0% C95.0% C I： 1.171.17 1.17-1.991.99 1.99]；p < 0.01). After adjusting for the above significant variables, intrafamilial factors associated significantly with self-rated health status were living arrangement stability and financial status. In gender specific analyses, self-rated health status in male elders were associated with chronic disease number, instrumental activities of daily living, living arrangement stability and financial status. Among female elders, the significant factors were chronic disease number, depressive symptoms, activities of daily living, leisure/entertainment.
Conclusion：
Chronic disease, activities of daily living, instrumental activities of daily living and depressive symtoms were strong predictors for self-rated health status. Intrafamilial factors associated with self-rated health status were living arrangement stability and financial status.

並列關鍵字

Self-rated heath status ； Elderly ； Predictors ； Long-term follow-up ； Taiwan

參考文獻

Abu-Omar K, Rütten A, Robine JM. Self-rated health and physical activity in the European Union. Soz Praventivmed. 2004;49(4):235-42.

Bath PA. Differences between older men and women in the self-rated health–mortality relationship. Gerontologist. 2003;43(3):387-95.

Benyamini Y, Leventhal EA, Leventhal H. Gender differences in processing information for making self-assessments of health. Psychosom Med. 2000;62(3):354-64

Borawski EA, Kinney JM, Kahana E. The meaning of older adults’ health appraisals: Congruence with health status and determinant of mortality. J Gerontol B Psychol Sci Soc Sci. 1996;51(3):S157-70.

Bodde AE, Seo DC, Frey G. Correlation between physical activity and self-rated health status of non-elderly adults with disabilities. Prev Med. 2009;49(6):511-4.