第2型糖尿病老人生活適應與死亡態度相關性之研究-以台北市立聯合醫院中興院區為例

Association of Life Adjustment and Attitudes towards Death among the Elderly with Type 2 Diabetes –Samples of the Zhongxing Branch of Taipei City Hospital

林美伶(Mei-Ling Lin)

指導教授 ： 黃松元

國立臺灣師範大學/教育學院/衛生教育學系/碩士(2005年)

摘要

本研究主要目的，在於了解罹患第2型糖尿病老人之基本資料變項（社會人口學變項、疾病特性）、生活適應與死亡態度之現況及相關性。本研究採橫斷式問卷調查法進行資料收集，以立意取樣選取台北市立聯合醫院中興院區新陳代謝科門診之病患共135人為研究對象。以描述性統計、單因子變異數分析、薛費氏事後檢定、皮爾森積差相關、多元迴歸分析等統計方法進行分析。
重要結果歸納如下：研究對象以女性、70-74歲、小學畢業或肄業、有宗教信仰、已婚、與配偶及子女或孫子女同住、經濟依賴、有從事休閒活動者居多。患病及治療年數以5年以下者居多、治療方式大多以口服降血糖藥為主、多數有合併症、大多血親沒有罹患糖尿病情形。研究對象在生理適應方面，以自覺健康狀況普通、罹患一項疾病以下、日常生活活動為獨立自主的老人居多，心理適應狀況為中上程度，社會適應狀況則為中等程度。對死亡抱持著坦然接受的態度。研究對象的生活適應隨著性別、年齡、教育程度、宗教信仰、婚姻狀況、居住安排、經濟狀況、休閒活動及患病年數、治療年數、治療方式（運動控制）、併發症情形的不同而有所差異。死亡態度隨著性別、宗教信仰、治療方式（針劑注射）、併發症情形的不同而有所差異。研究對象之生活適應與死亡態度相關性，「自覺健康狀況」越好，越傾向於「趨近導向的死亡接受」，越不會傾向於「解脫導向的死亡接受」；疾病影響程度越大，越傾向於「解脫導向的死亡接受」。心理適應越好，越不會傾向於「解脫導向的死亡接受」。社會適應好壞與死亡態度之間無顯著性相關。
在生活適應量表方面，自覺健康狀況層面中，經濟狀況、休閒活動、併發症情形為預測因子，可解釋變異量為21.4％；罹病狀況層面中，患病年數、針劑注射為預測因子，可解釋變異量為6.2％；疾病影響程度及項目層面中，性別、年齡、運動控制、針劑注射為預測因子，可解釋變異量為21.6％。心理適應方面，年齡、婚姻狀況、休閒活動、併發症情形為預測因子，可解釋變異量為36.6％。社會適應方面，教育程度、婚姻狀況、休閒活動、併發症情形為預測因子，可解釋變異量為33.8％。在死亡態度量表方面，死亡恐懼分量表中，針劑注射為預測因子，可解釋變異量為3.2％；趨近導向的死亡接受分量表中，宗教信仰為預測因子，可解釋變異量為3.7％；解脫導向的死亡接受分量表中，併發症情形為預測因子，可解釋變異量為4.6％。
最後針對本研究過程及結果，提出後續可努力的方向，作為糖尿病衛生教育及未來研究之參考。

關鍵字

第2型糖尿病 ； 老人 ； 生活適應 ； 死亡態度

並列摘要

The purpose of this study was to explore the condition and association of basic data(demographic variables, characteristics of illness), life adjustment and attitudes towards death of elderly with type 2 Diabetes. Data were collected by using cross-sectional questionnaire survey and purposive sampling was used to interview totally 135 elders in the metabolic outpatient department at Zhongxing Branch of Taipei City Hospital. The data was analyzed by frequency distribution, one-way ANOVA, post Scheff’s examination, Pearson product-moment correlation, and multiple regression analysis.
The main results can be summarized as follows: the majority of the subjects were female, 70-74years old, graduated from elementary school or study in elementary school, had religious belief, married, lived with spouse and children or grandchild, economical dependent, took leisure activities. The most duration of diabetes and medication was below 5 years. The most frequent way of treatment was taking oral hypoglycemic agents. Most subjects had complications and most of their relatives had no diabetes. In the physiological adjustment aspect, the major of the subjects perceived their health status ordinary, got disease below one item, activities of daily living independent. Their psychological adjustment was above the average, and social adjustment was at moderate-inferior degree. In the attitudes towards death aspect, they accepted death peacefully. The life adjustment of the subjects vary significantly with sex, age, educational levels, religious belief, marriage, living arrangement, economical condition, leisure activity and the duration of diabetes and medication, the way of treatment (exercise control), the condition of complication.The attitudes towards death vary significantly with sex, religious belief, the way of treatment (take hypoglycemia by injection), the condition of complication. The relationships between life adjustment and attitudes towards death: the better they perceived their health status, the more they tend to approach acceptance and the less tend to escape acceptance. The more the impact level of disease, the more tend to escape acceptance. The better the psychological adjustment, the less tend to escape acceptance. Social adjustment and attitudes towards death had not significant relationship.
In the scale of life adjustment, the variables of economical condition, leisure activity and the condition of complication explained 21.4％ of the variance of perceiving health status. The duration of diabetes and taking hypoglycemia by injection explained 6.2％ of the variance of the state of illness. Sex, age, exercise control, take hypoglycemia by injection explained 21.6％ of the variance of the impact level and item by illness. Age, marriage, leisure activity, the condition of complication explained 36.6％ of the variance of psychological adjustment. Educational levels, marriage, leisure activity and the condition of complication explained 33.8％ of the variance of social adjustment. In the scale of the attitudes towards death, taking hypoglycemia by injection explained 3.2％ of the variance of fear of death ； religious belief explained 3.7％ of the variance of approach acceptance ； the condition of complication explained 4.6％ of the variance of escape acceptance .
Based on the findings of the study, nine recommendations have been drawn for the purpose of implementing diabetes health education programs and research projects in the future.

並列關鍵字

type2 DM ； elderly ； life adjustment ； attitudes towards death