感覺功能損傷對老人生活品質的影響：中間機制與調節效果之探討

The mediating mechanism and moderating effect of sensory impairment on quality of life among older adults

曾雅涓(Ya-Chuan Tseng)

指導教授 ： 羅美芳

國立臺灣大學/醫學院/護理學研究所/博士(2020年)

https://doi.org/10.6342/NTU202100683

摘要

研究背景：感覺功能損傷是老人常見的健康問題，感覺功能損傷不僅影響老人的身體功能、認知功能與溝通能力，並容易產生負向的情感，例如低自尊、憂鬱。感覺功能損傷也會影響老人外出與人互動的意願，導致社交隔離與孤寂感。

研究目的：本研究目的為探討聽力損傷、視力損傷以及雙重感覺功能損傷對老人生活品質的影響，分析個人本身的身體功能與憂鬱在感覺功能損傷對老人生活品質影響的中間機制，並且檢視外在的社會支持與社會參與在感覺功能損傷對老人生活品質影響的調節效果。

研究方法：本研究為橫斷式研究設計，樣本來源為臺北市三個社區65歲以上老人，總計研究對象600位。利用聽力與視力儀器測量，以及結構式問卷進行資料收集，問卷內容包括：臺灣簡明版世界衛生組織生活品質問卷、多向度功能評估量表、10題流行病學研究中心憂鬱量表、6題Lubben社會網絡量表、社會參與量表。本研究資料以描述性統計呈現研究對象基本屬性與聽力及視力情形，以多類別邏輯迴歸模型與處理機率倒數加權法檢視感覺功能損傷對生活品質的影響，以加權迴歸模型的方式分析身體功能與憂鬱所扮演中間機制的角色，並以階層迴歸模型的方式檢視社會支持與社會參與在感覺功能損傷對生活品質的影響之調節效果。

研究結果：本研究發現為：(1)62.3%的老人屬於「感覺功能正常」，25.6%的老人屬於「聽力損傷」，6.8%的老人屬於「視力損傷」，5.3%的老人屬於「雙重感覺功能損傷」；(2)排除自我選擇的問題後，發現感覺功能正常組的老人比聽力損傷組、視力損傷組，以及雙重感覺功能損傷組的老人有更好的生活品質；(3)身體功能在感覺功能損傷對老人生活品質影響的中間效果顯著，其中間影響力達37.0～58.9%；(4)憂鬱在感覺功能損傷對老人生活品質影響的中間效果顯著，其中間影響力達63.3～86.8%；(5)社會支持在感覺功能損傷對老人生活品質的影響上具有調節作用；(6)社會參與在感覺功能損傷對老人生活品質的影響上具有調節作用。

結論：本研究證實感覺功能損傷對老人生活品質有顯著的影響，藉此冀望能喚醒社會大眾對於老人感覺功能損傷議題的重視。此外，本研究證實身體功能與憂鬱為感覺功能損傷與生活品質的中間變項，能提供醫護人員未來在照顧感覺功能損傷老人的臨床照護之重要參考，提升老人的照顧品質。本研究建議未來應致力於強化感覺功能損傷老人的社會支持，並且鼓勵參與社會活動，以提升老人的生活品質。

關鍵字

老人 ； 生活品質 ； 感覺功能損傷 ； 中間機制 ； 調節效果 ； 反事實因果推論 ； 處理機率倒數加權法

並列摘要

Background: Sensory impairment is a common health problem among older adults affecting their physical and cognitive functions and ability to communicate and tending to engender negative moods such as low self-esteem and depression. It also has an impact on the willingness of older adults to leave their dwellings and interact with others, resulting in social isolation and loneliness.

Aims: The objective of our study was to investigate the impact of hearing impairment, visual impairment and dual sensory impairment on quality of life among older adults. We analyzed the mediating mechanism of individual physical function and depression on the impact of sensory impairment on quality of life among older adults and examined the moderating effects of external social support and social participation on the impact of sensory impairment on quality of life among older adults.

Methods: This was a cross-sectional study of 600 people aged 65 or over living in three districts of Taipei City. We gathered information through instrument testing of hearing and vision and from a structured questionnaire. The questionnaire was created using the World Health Organization Quality of Life Instrument, short form (WHOQOL-BREF Taiwan Version), the Multidimensional Functional Assessment Questionnaire (MFAQ), the 10-item version of the Center for Epidemiological Studies Depression Scale (10-item CES-D), the 6-item version of the Lubben Social Network Scale (LSNS-6) and the Social Participation Questionnaire (SPQ). We treated the data as follows: (1) the demographic characteristics and the hearing and vision functions of the subjects were presented as descriptive statistics; (2) the multinomial logistic regression model and inverse probability treatment weighting were applied to examine the effects of sensory impairment on quality of life; (3) the weighted regression model was utilized to analyze the roles of physical function and depression as mediating mechanisms; and (4) the hierarchical regression model was utilized to examine the moderating effects of social support and social participation on the impact of sensory impairment on quality of life.

Results: The results of the study were as follows: (1) sixty-two percent of older adults had normal sensory function, 25.6% had hearing impairment, 6.8% had visual impairment, and 5.3% had dual sensory impairment; (2) after eliminating self-selection bias, the normal sensory function group had the highest quality of life scores, followed by the hearing impaired alone, the visual impaired alone, and the dual sensory impairment groups; (3) the physical function mediated the effects of sensory impairment on quality of life among older adults, accounting for 37.0% to 58.9% of observed variation; (4) the depression mediated the effects of sensory impairment on quality of life among older adults, accounting for 63.3% to 86.8% of observed variation; (5) social support had a moderating effect on the impact of sensory impairment on quality of life among older adults; and (6) social participation also had a moderating effect on the impact of sensory impairment on quality of life among older adults.

Conclusions: Our study showed that sensory impairment has a significant impact on quality of life among older adults. We hope that our findings will help awaken public awareness of the issue of sensory impairment among older adults. Our study also showed that physical function and depression act as mediators of the link between sensory impairment and quality of life among older adults. The findings may serve as a reference for medical personnel in facing and dealing with these similar clinical situations and older adults with sensory impairment in the future. We recommend putting efforts into strengthening social support for older adults with sensory impairment and encouraging them to engage in social activities in order to improve their quality of life.

並列關鍵字

older adults ； quality of life ； sensory impairment ； mediating mechanism ； moderating effect ； counterfactuals and causal inference ； inverse-probability of treatment weighted

參考文獻

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