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  • 學位論文

探討台灣老人居住安排模式與功能性健康狀態改變之關係:台灣長期追蹤研究之結果分析

The Association between Living Arrangements and Change in Functional Health Status among the Elderly in Taiwan: Results of a National Cohort Study

指導教授 : 李孟智 顏啟華

摘要


目的: 人口老化在全球已發展的國家中皆為棘手且急需要面對的議題。現今的台灣,家庭依然是老人最能接受的方式,然而因為社會和家庭觀念的改變,有漸多的老人以獨居或僅與配偶的方式居住。目前有關老人居住安排的研究並不豐富,且多來自橫斷面研究結果。 先前的文獻多以身體功能來探討老人未來居住安排的改變,較少以居住安排來分析老人失能程度。因此本研究之目的有二: (1)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」第五波2003年及第六波2007年之問卷資料,探討影響老人身體功能改變之因素,(2)並分析不同的居住模式在無變動的情況下與四年後身體功能改變的關係。 方法: 研究以2003年第五波調查為基期,再進一步追蹤2007年第六波調查之身體功能的狀況。篩選條件為年齡≧60歲、兩波調查均有資料者、四年內居住狀況未改變和兩波調查皆有測IADL和ADL。最後納入研究分析的總人數為1,100人。將該族群依2003年的居住模式分成三組: 獨居、與配偶、與配偶加其他。以2003年的性別、年齡、婚姻狀況、經濟狀況、自覺健康狀態、身體功能指標、心理功能指標和共存疾病等為自變項,2003年至2007年間的身體功改變為依變項,先以卡方檢定作為各項因子對身體功改變的單變項分析,再將卡方檢定有顯著意義之變項進行邏輯式回歸分析,探討各個因素對身體功改變之相關性與預測能力。同時分析三個不同的居住模式在無變動的情況下與四年後身體功能改變的關係。 結果: 經過四年的追蹤,納入分析的1,100人當中,整體身體功能(overall ADL)大多數沒有改變佔776人(70.6%), 其中變好的人有164人(14.9%),變差的人共159人(14.5%)。針對變差的族群迴歸分析後發現: 自覺健康(RR:1.57 [95% CI:1.25-1.98])、認知障礙(RR:2.20 [95% CI:1.38-3.50])、居住狀況分組中的與其他同住者(RR:2.23 [95% CI:1.14-4.37])、年齡(RR:2.33 [95% CI:1.80-3.00])等依序由弱至強仍為整體身體功能變差的獨立預測因子。如將整體身體功能再分層為IADL和ADL進一步分析,發現預測IADL變差的獨立因子有自覺健康(RR:1.50 [95% CI:1.19-1.90])、年齡(RR:1.89 [95% CI:1.46-2.44])、中風(RR:1.94 [95% CI:1.01-3.73]); 預測ADL變差的獨立因子則為年齡(RR:2.56 [95% CI:1.71-3.81])、自覺健康 (RR:2.66 [95% CI:1.70-4.16])、認知障礙(RR:3.76 [95% CI:1.87-7.53])和居住狀況分組中的與其他同住者(RR:4.73 [95%CI:1.08-20.71])。分析居住狀態與整體身體功能變差的關係,以獨居者當基準(1.00)相比,發現與配偶居住者之身體功能變較差(RR:1.23 [95% CI:0.61-2.47]),與其他人居住者身體功能變更差(RR:1.74 [95% CI:0.94-3.31]),但兩者皆無統計學上意義。如果再將與其他人居住者跟與配偶者相比(RR:1.44 [95% CI:0.95-2.18]),同樣得到類似的趨勢,即與其他人居住者身體功能變差的程度還是最明顯,但亦無統計學上意義。 結論: 本研究告訴了我們獨居者年齡皆較老,但是身體和心理功能皆較健康,自覺健康狀態也較佳,身體功能在四年間衰退的較慢。

關鍵字

身體功能 居住安排 ADL IADL 老人 長期追蹤 台灣

並列摘要


Objectives: Limited prospective data have examined the associatation between living arrangements and change in functional health. This study aimed to evaluate this association and to explore factors that might predict decline in functional health among the general elderly population in Taiwan. Methods: Data were collected from the “Survey of Health and Living Status of the Elderly in Taiwan”, a national longitudinal study which started as early as 1989. At baseline in 2003, a total of 1,100 community-dwelling subjects, aged≧60 years, were questioned and followed up until 2007. Respondents were divided into three groups according to living arrangements at study entry: living alone, living with a spouse, and living with spouse plus others (e.g., children, other relatives and/or any care-giver). Potential confounders including sociodemographic and health variables, such as gender, age, marital status, financial status, self-rated health, mental health and coexisting diseases, were obtained and analyzed at baseline (2003). Over this four-year period, functional health was measured both in 2003 and 2007 as the sum of limitations in six physical (ADL) and six instrumental activities of daily living (IADL). The outcome variables were any change in functional health defined as the difference in score between the 2003 and 2007 measures (2003 score minus 2007 score) and were subsequently recorded as a change in Overall ADL, IADL, or ADL – specifically “+” denoting improvement, “0” indicating no change, and “-“ meaning decline in functional health status. For this study, decline in functional health in particular was selected for analysis. Multivariate logistic regression was used to evaluate predicting factors for decline in functional health status with p<0.05 representing statistical significance. The association between living arrangements and decline in functional health was also explored. Results: Of the 1,100 elderly subjects over the 4-year period, 14.9% (N=164) had improvement in functional health while 14.5% (N=159) had a decline. Most elderly (70.6%, N=776) remained unchanged. For those with a decline in Overall ADL, self-rated health (RR:1.57[95%CI:1.25-1.98]), cognitive impairment (RR:2.20[95%CI:1.38-3.50]), living with spouse plus others (RR:2.23[95%CI:1.14-4.37]) and age (RR:2.33[95%CI:1.80-3.00]) were found to be independent predicting factors. Regarding the association between living arrangements and physical functional health, those living alone had least decline in overall physical function, living with a spouse was worse than living alone (RR:1.23[95% CI:0.61-2.47]), and living with spouse plus others (RR:1.74[95% CI:0.94-3.31]) had the greatest decline among these three groups.

並列關鍵字

physical function living arrangement cohort study ADL IADL Taiwan

參考文獻


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