Title

休閒活動對老人工具性日常活動失能的影響-一個縱貫性研究

Translated Titles

The influence of leisure activities on the disability of the elderly's instrumental daily activities –A longitudinal study

DOI

10.6834/csmu202100262

Authors

劉千榆

Key Words

工具性日常活動功能 ; 休閒活動 ; 老人 ; 失能 ; Instrumental Activities of Daily Living ; Leisure activities ; Elderly ; Disability

PublicationName

中山醫學大學護理系長期照護碩職專班學位論文

Volume or Term/Year and Month of Publication

2021年

Academic Degree Category

碩士

Advisor

李淑杏

Content Language

繁體中文

Chinese Abstract

研究背景與目的:高齡化社會已是目前全球人口變遷之趨勢,文獻顯示全球失能的人口超過十億人罹患某種形式的失能,並隨著人口老化持續成長。過去研究已提及老人休閒活動參與的重要性,參與休閒活動能使老人的功能障礙進展趨向緩慢。社會中有許多因子共存互相影響的狀況,本研究更進一步在不同的「休閒活動」中將老人的「年齡」及「性別」做分層分析,補足過去文獻較少提及,在年齡層的老人與性別差異對IADL失能的各別調節效應影響的研究缺口。基於上述研究背景與動機,本研究目的為分析『臺灣地區中老年身心社會生活狀況長期追蹤調查』探討臺灣不同的休閒活動對老人IADL失能的影響及其相關因子探討。 研究方法:本研究為縱貫性長期追蹤研究設計,使用『衛生福利部國民健康署』2007年(第六波)及2011年(第七波)辦理之『臺灣地區中老年身心社會生活狀況長期追蹤調查』之問卷調查資料。資料庫分析數據是以2007年時65歲以上存活及IADL功能正常之老年個案為研究樣本,含男性1,300人,女性1,271人,共計2,571人。受訪個案所陳述其休閒活動情形來追蹤探討個案在其後續4年(自2007年至2011年)期間之失能狀況,研究其相關性。採用SAS 9.4版統計軟體進行資料分析,描述性統計含個數、百分比、平均值及標準差,推論性統計含卡方檢定、t-test及邏輯式迴歸進行分析。 結果:本研究IADL失能的平均年齡是75.21(±6.33)歲,年齡≥75歲有較高的失能趨勢佔52.56%,IADL失能者多數為男性佔52.82%。將老人所參與的休閒活動區分為「智力型」、「體力型」、「社交型」三組的休閒活動,研究發現參與「智力型」和「社交型」休閒活動可以預防IADL失能(OR=0.73, p = 0.0019, 95%CI [0.59,0.89];OR=0.66, p = 0.011, 95%CI [0.48,0.91]),因此提供「智力型」和「社交型」休閒活動對於IADL失能具統計顯著性之保護作用。本研究更進一步將年齡分層分析後發現,年齡65-74歲「智力型」休閒活動為邊際統計顯著性(OR=0.77, p =0.0585, 95%CI [0.59,1.01]);年齡≥75歲在「智力型」和「社交型」休閒活動均對IADL失能達統計顯著(OR=0.63, p =0.0053, 95%CI [0.46,0.87]及0.58, p=0.0411, 95%CI [0.34,0.98])。在進行邏輯式迴歸性別分層分析後,結果顯示男性在「智力型」(OR=0.70, p =0.0071, 95%CI [0.54,0.91])和「社交型」(OR=0.63, p =0.027, 95%CI [0.42,0.95])是有顯著保護作用。 結論:本研究建議65歲以上的老人多參與「智力型」和「社交型」休閒活動能降低IADL失能。在進行預防及延緩失能照護衛教時,男性可以給予「智力型」和「社交型」的衛教資訊,對於預防及延緩IADL失能會較有顯著的效果。

English Abstract

Objectives:An aging society has become the current trend of global population migration. The literature shows that one billion people lost in the global population will lose their ability with age and continue to grow with age. Social activities slow down the functional progress of the elderly. Analyze, supplement the previous IA knowledge, the research report in the region where the elderly and gender differences affect the effect of the other-level moderating effect on disability. Based on the above research background and motives, the purpose of this research is to investigate the influence of long-term different leisure activities in Taiwan on the disability of the elderly and related factors. Methods:This research is a longitudinal long-term follow-up research design, using the “Long-term follow-up survey on the mental and social life of middle-aged and elderly people in Taiwan” conducted by the National Health Administration of the Ministry of Health and Welfare in 2007 (the sixth wave) and 2011 (the seventh wave) The questionnaire survey data. The database analysis data is based on the elderly cases over 65 years of age and normal IADL function in 2007 as the research sample, including 1,300 males and 1,271 females, a total of 2,571 people. The interviewed case's state of leisure activities is used to track and explore the disability status of the case during the subsequent 4 years (from 2007 to 2011), and to study its relevance. Use SAS 9.4 version of statistical software for data analysis. Descriptive statistics include number, percentage, average and standard deviation, and inferential statistics include chi-square test, t-test and logistic regression for analysis. Results:In this study, the average age of IADL disability was 75.21 (±6.33) years old, 52.56% of the age ≥ 75 years old had a higher tendency of disability, and the majority of IADL disability was male, accounting for 52.82%. The leisure activities that the elderly participate in are divided into three groups of leisure activities: "intellectual", "physical" and "social". The study found that participating in "intellectual" and "social" leisure activities can prevent IADL disability (OR =0.73, p = 0.0019, 95%CI [0.59,0.89]; OR=0.66, p = 0.011, 95%CI [0.48,0.91]), therefore, providing "intellectual" and "social" leisure activities is not the Can have a statistically significant protective effect. This study further analyzed the age stratification and found that “intellectual” leisure activities aged 65-74 years old were statistically significant at the margin (OR=0.77, p=0.0585, 95%CI [0.59,1.01]); age ≥75 Both "intellectual" and "social" leisure activities have statistically significant effects on IADL disability (OR=0.63, p=0.0053, 95%CI [0.46,0.87] and 0.58, p=0.0411, 95%CI [0.34] ,0.98]). After performing a logistic regression gender stratification analysis, the results showed that men are in the "intelligence type" (OR=0.70, p =0.0071, 95%CI [0.54,0.91]) and the "social type" (OR=0.63, p =0.027). , 95%CI [0.42,0.95]) is a significant protective effect. Conclusion:This study suggests that elderly people over 65 participate in "intellectual" and "social" leisure activities to reduce IADL disability. In the prevention and delay of disability care, men can give "intellectual" and "social" health education information, which will have a significant effect on preventing and delaying IADL disability.

Topic Category 醫藥衛生 > 社會醫學
醫學院 > 護理系長期照護碩職專班
Reference
  1. 中華民國內政部統計處(2020).107年第15週內政統計通報(107年4月14日).2020年5月取自https://www.moi.gov.tw/files/site_node_file/7635/week10715.pdf
  2. 中華民國內政部統計處(2020).109年第32週內政統計通報(108年國人平均壽命達80.9歲,再創新高).2020年8月取自https://www.moi.gov.tw/stat/news_detail.aspx?sn=18425
  3. 王儒聰、江秀玲、吳予丹(2016).物理治療對居家個案疼痛介入之應用.長期照護雜誌,20(1),35-41。doi:10.6317/LTC.20.35
  4. 王顏和譯(2011).國際機能、失能和健康分類。衛生署委託「國際健康功能與身心障礙分類系統-兒童與青少年版推動計畫」 (99M4073)。
  5. 何曉婷、劉立凡、郭乃文(2016).台灣南部地區老年憂鬱情緒之影響因子探討.台灣家庭醫學雜誌,26(2),100-108。doi: 10.3966/168232812016062602004
  6. 吳昌政、邱靜如、黃湘閔、呂宗學(2018).臺灣中老人中風後身體功能變化歷程之性別差異探討.健康科技期刊,80-92。doi: 10.6979/TJHS.201812/SP.0008
  7. 呂寶靜(2008).臺灣老人參與休閒活動效益之初探「高齡社會的來臨」國科會研究成果發表暨學術研討會。發表論文,臺大凝態科學館。
  8. 宋雅俐(2014).臺灣老人口失能趨勢之探討-以臺灣地區中老年身心社會生活狀況長期追蹤調查為例.國立臺北護理健康大學長期照護研究所學位論文(未出版之碩士論文),臺北市。
  9. 李力昌(2005).休閒社會學.臺北:偉華。
  10. 李庚霖、區雅倫、陳淑惠、翁儷禎(2009).臺灣地區中老年身心社會生活狀況長期追蹤調查短版 CES-D 量表之心理計量特性.中華心理衛生學刊, 22(4), 383-410。doi:10.30074/FJMH.200912_22(4).0002
  11. 李素馨、侯錦雄、林宗賢、黄章展、葉源鎰(2011).休閒遊憩行為.臺北市:華都文化。
  12. 沈彥菱(2014).探討臺灣老人社會支持對工具性日常生活功能之影響.中山醫學大學護理學系學位論文(未出版之碩士論文),臺中市。doi:10.6834/CSMU.2014.00121
  13. 周玉慧、莊義利(2000) .「晚年生活壓力、社會支持與老人身心健康知變遷:長期資料分析」.人文及社會科學集刊,12卷2期:281-317。
  14. 周宇翔、李淑貞、謝東儒、張聿淳(2017).身心障礙鑑定與需求評估制度實施經驗探討.臺灣社會工作學刊,(18),113-115。
  15. 周嘉琪、王俊明(2012).安養護機構老人之健身運動與自尊模式.大專體育學刊,14(4),438-447。doi:10.5297/ser.1404.004
  16. 林志鈞、江慧欣(2015).銀髮族參與休閒活動、休閒涉入及休閒效益對成功老化之關係.育達科大學報,第40期,57-86頁。
  17. 林志鈞、葉嘉文(2018).新北市退休教師休閒參與、老化態度、社會支持對生命意義之影響.全球商業經營管理學報,(10),133-146。
  18. 林怡君(2016).身體活動與高齡者情緒調適和記憶能力關係之探究.屏東大學教育心理與輔導學系碩士班學位論文(未出版之碩士論文),屏東市。
  19. 翁菁甫、林坤霈、詹鼎正(2014).老人抑鬱與認知功能障礙.內科學誌,25(3),158-164。doi:10.6314/JIMT.2014.25(3).05
  20. 國家發展委員會(2020).人口推估查詢系統-中華民國人口推估(2020至2070年)高齡化指標.2020年9月取至https://pop-proj.ndc.gov.tw/chart.aspx?c=10 uid=66 pid=60
  21. 國家發展委員會(2020).統計分析圖表彙編人口推估人口成長趨勢.2021年4月取至https://www.ndc.gov.tw/Content_List.aspx?n=0F11EF2482E76C53
  22. 國家發展委員會(2020).統計分析圖表彙編人口推估高齡化時程.2021年4月取至https://www.ndc.gov.tw/Content_List.aspx?n=6EA756F006B2A924
  23. 國家發展委員會(2020).統計分析圖表彙編人口推估國際比較.2021年4月取至https://www.ndc.gov.tw/Content_List.aspx?n=6EA756F006B2A924
  24. 張炳華、劉美玉、林川雄、馮兆康(2014).中風患者及其主照顧者對於出院準備服務之滿意度分析-以中部某區域教學醫院為例.管理實務與理論研究,8(1),26-41。
  25. 張毓蓉、陳耀仁、蘇俊郎、陳明義(2015).ICF模式應用於輔助溝通系統評估之探討:以複雜性溝通需求者為例.臺灣聽力語言學會雜誌,第34期:21-52。doi:10.6143/JSLHAT.2015.04.02
  26. 張綺芬(2012).聽語學報第45期-從語言治療師的角度看ICF與新制身心障礙鑑定.2020年5月取自https://www.slh.org.tw/index.php?do=news tpid=5 pid=52 id=801
  27. 梁慧君、李世昌、王月鶯(2013).臺中市高齡族群休閒活動參與、成效及生活滿意度之研究.亞洲高齡健康休閒及教育學刊,2(1),24-38。doi:10.6262/ASHLE.201310_2(1).0003
  28. 陳依靈、魏惠娟、黃清雲(2018).高齡者認知功能與身體活動之探討. 嘉大體育健康休閒期刊,17(2),74-88。doi:10.6169/NCYUJPEHR.201808_17(2).06
  29. 陳惠真、王香蘋(2005).臺灣老人健康狀況初探:1989年至1999年.臺灣家庭醫學雜誌,15卷1期,25-35。doi: 10.7023/TJFM.200503.0025
  30. 陳彰儀(1989).工作與休間-從工業心理學的觀點探討休閒的現況與理論。臺北:淑馨。
  31. 曾鈺婷、蔡佳良(2010).阻力運動訓練對老人認知功能之輔助效益.大專體育,(111),75-82。doi:10.6162/SRR.2010.111.11
  32. 游曉微、陳雅美(2015).臺灣老人失能趨勢之回顧.長期照護雜誌, 19(2),157-186。 doi:10.6317/LTC.19.157
  33. 黃淑貞、林春鳳(2010).銀髮族休閒活動參與對生活滿意度相關文獻之探討.2010 年第三屆運動科學暨休閒遊憩管理學術研討會論文集.國立屏東教育大學。
  34. 黃森芳、陳杰、陳威澄(2020).增加身體活動預防癌症的效果:文獻回顧.內科學誌,31:180-188。doi:10.6314/JIMT.202006_31(3).06
  35. 楊慧瑩(2015).成功老化之軌跡活動、其相關影響因素及其後續健康影響之探討.104學年度學生研究計畫補助。
  36. 廖玟玲(2015).中老人工具性日常生活活動失能軌跡與健康餘命.中國醫藥大學公共衛生學系碩士班學位論文(未出版之碩士論文),臺中市。doi: 10.6830/CMU.2015.00166
  37. 廖俊正(2015).社會支持對死亡的影響在臺灣不同教育程度老人中的差異.中山醫學大學醫學研究所學位論文(未出版之博士論文),臺中市。doi:10.6834/CSMU.2015.00137
  38. 臺灣復健醫學會(2020).國際健康功能與身心障礙分類系統(ICF)翻譯.2020年5月取自https://www.pmr.org.tw/icf/icf.asp
  39. 趙育晟(2011).台灣老年人身體功能之軌跡分析.中山醫學大學公共衛生學系碩士班學位論文(未出版之碩士論文),臺中市。doi:10.6834/CSMU.2011.00081
  40. 劉千嘉(2018).高齡家庭與高齡照顧者的特性:2010 年人口與住宅普查資料的應用.人口學刊第56期,81-119。doi:10.6191/JPS.201806_56.0003
  41. 歐聖榮(2011).休閒遊憩:理論輿實務。新北市:前程文化。
  42. 蔡衣帆、陳頌云、侯春梅(2018).社區居家照顧服務之成效.北市醫學雜誌,15(4),34-47。
  43. 蔡怡萱(2019).健康促進行為與心理因子對糖尿病相關之失能預防研究.成功大學老年學研究所學位論文,1-68。doi: 10.6844/NCKU201902083
  44. 衛生福利部(2020).長照政策專區-長照十年計畫2.0 建立我國社區整體照顧模式,佈建綿密照顧網.2020年7月取自https://1966.gov.tw/LTC/cp-3636-42415-201.html
  45. 衛生福利部(2020).衛生福利統計專區-2.3.1 身心障礙者人數按季 (2020 年8月31日).2020年9月取自https://dep.mohw.gov.tw/DOS/lp-2976-113.html
  46. 衛生福利部(2020).衛生福利統計專區-2.3.5 身心障礙者人數按類別及年齡別分(2020 年5月28日).2020年8月取自https://dep.mohw.gov.tw/DOS/lp-2976-113.html
  47. 衛生福利部長照政策專區(2020).107年長照給付及支付基準及相關推動事宜(2018 年01月09日).2020年12月取至https://www.mohw.gov.tw/dl-49447-5592e483-cbf9-4846-8c43- 749b567f4fcb.html
  48. 鄭伊萍(2013).老人失能之概念分析.身心障礙研究季刊,11卷2期,128-139。
  49. 蕭崑杉、盧俊吉(2012).持續性成功老化的休閒與社會支持機制研究.臺灣老人保健學刊,8(2)。doi:10.29797/TJGHR.201212.0005
  50. 蕭竫榆(2013).身體活動對臺灣老年人身體功能之影響: 11年追蹤研究.成功大學公共衛生研究所學位論文,1-104。doi:10.6844/NCKU.2013.00856
  51. 蕭維誌( 2017).失能高齡者健康、生活活動及影響因子探討.中山醫學大學醫學社會暨社會工作學系碩士班學位論文(未出版之碩士論文),臺中市。
  52. 賴妤甄(2015).台灣老年人憂鬱之軌跡分析.中山醫學大學公共衛生學系碩士班學位論文(未出版之碩士論文),臺中市。doi:10.6834/CSMU.2015.00102
  53. 謝欣潔(2013).臺北市高職特教班學生休閒活動現況之調查研究.國立臺北教育大學特殊教育學系學位論文,1-118。
  54. 魏正、夏綠荷(2014).銀髮族休閒參與興趣,影響因素與目的之初探─ 以高雄市銀髮族為例.淡江體育學刊,(17),28-37。
  55. 蘇昭儒、歐威廷、歐玲君(2016).醫療臨床工作者的觀點探討臺灣居家照護的現況與未來.臺灣老年醫學暨老年學雜誌,11(4),237-248。doi:10.29461/TGG.201611_11(4).0003
  56. Adams, K. B., Leibbrandt, S., Moon, H. (2011). A critical review of the literature on social and leisure activity and wellbeing in later life. Ageing Society, 31(4), 683-712.
  57. An, R., Xiang, X. (2015). Smoking, heavy drinking, and depression among US middle-aged and older adults. Preventive medicine, 81, 295-302.
  58. Ayto, J. (1991). Making sense of foreign words in English. Chambers.
  59. Balzi, D., Lauretani, F., Barchielli, A., Ferrucci, L., Bandinelli, S., Buiatti, E., ... Guralnik, J. M. (2010). Risk factors for disability in older persons over 3-year follow-up. Age and Ageing, 39(1), 92-98.
  60. Bherer, L., Erickson, K. I., Liu-Ambrose, T. (2013). A review of the effects of physical activity and exercise on cognitive and brain functions in older adults. Journal of aging research.
  61. Cattell, R. B. (1971). Abilities: Their structure, growth, and action.
  62. Chao, S. F. (2016). Changes in leisure activities and dimensions of depressive symptoms in later life: A 12-year follow-up. The Gerontologist, 56(3), 397-407.
  63. Chen, C. M., Lee, I. C., Shih, P. S., Chiu, H. C. (2017). Health Decline in the Elderly: Course and Interrelationships with Major Associated Factors. The Changhua Journal of Medicine, 15(4), 165-175.
  64. Chen, T. Y., Chang, H. Y. (2016). Developmental patterns of cognitive function and associated factors among the elderly in Taiwan. Scientific reports, 6(1), 1-10.
  65. Chen, Y. M., Tu, Y. K., Yu, H. W., Chiu, T. Y., Chiang, T. L., Chen, D. R., Chang, R. E. (2018). Leisure time activities as mediating variables in functional disability progression: An application of parallel latent growth curve modeling. PloS one, 13(10), e0203757.
  66. Gill, T. M., Gahbauer, E. A., Lin, H., Han, L., Allore, H. G. (2013). Comparisons between older men and women in the trajectory and burden of disability over the course of nearly 14 years. Journal of the American Medical Directors Association, 14(4), 280-286.
  67. Han, A., Kim, J., Kim, J. (2019). Coping Strategies, Social Support, Leisure Activities, and Physical Disabilities. American journal of health behavior, 43(5), 937-949.
  68. Harris, A. H., Cronkite, R., Moos, R. (2006). Physical activity, exercise coping, and depression in a 10-year cohort study of depressed patients. Journal of affective disorders, 93(1-3), 79-85.
  69. Hybels, C. F., Pieper, C. F., Blazer, D. G., Fillenbaum, G. G., Steffens, D. C. (2010). Trajectories of mobility and IADL function in older patients diagnosed with major depression. International journal of geriatric psychiatry, 25(1), 74-81.
  70. Jessup, G. M., Cornell, E., Bundy, A. C. (2010). The treasure in leisure activities: Fostering resilience in young people who are blind. Journal of Visual Impairment Blindness, 104(7), 419-430.
  71. Jones, A. (2012). Disability, health and generation status: how Hispanics in the US fare in late life. Journal of immigrant and minority health, 14(3), 467-474.
  72. Kelly, J. R. (1990). Leisure and aging: A second agenda. Loisir et Societe/Society and Leisure, 13(1), 145-167.
  73. Kirk-Sanchez, N. J., McGough, E. L. (2014). Physical exercise and cognitive performance in the elderly: current perspectives. Clinical interventions in aging, 9, 51.
  74. Kohout FJ, Berkman LF, Evans DA, Cornoni-Huntley J (1993). Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. J Aging Health, 5: 179-93.
  75. Lantz, P. M., Golberstein, E., House, J. S., Morenoff, J. (2010). Socioeconomic and behavioral risk factors for mortality in a national 19-year prospective study of US adults. Social science medicine, 70(10), 1558-1566.
  76. Lawton, M. P., Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9(3),179-186.
  77. Liang, J., Wang, C. N., Xu, X., Hsu, H. C., Lin, H. S., Lin, Y. H. (2010). Trajectory of functional status among older Taiwanese: Gender and age variations. Social science medicine, 71(6), 1208-1217.
  78. Lubitz, J., Cai, L., Kramarow, E., Lentzner, H. (2003). Health, life expectancy, and health care spending among the elderly. New England Journal of Medicine, 349(11), 1048-1055.
  79. Maass, A., Düzel, S., Goerke, M., Becke, A., Sobieray, U., Neumann, K., ... Düzel, E. (2015). Vascular hippocampal plasticity after aerobic exercise in older adults. Molecular psychiatry, 20(5), 585-593.
  80. Murdock, C. (1992). A critical evaluation of the Barthel Index, part 1. British Journal of Occupational Therapy, 55(3), 109-111.
  81. Olaya, B., Domènech-Abella, J., Moneta, M. V., Lara, E., Caballero, F. F., Rico-Uribe, L. A., Haro, J. M. (2017). All-cause mortality and multimorbidity in older adults: The role of social support and loneliness. Experimental gerontology, 99, 120-126.
  82. Penninx, B. W., Leveille, S., Ferrucci, L., Van Eijk, J. T., Guralnik, J. M. (1999). Exploring the effect of depression on physical disability: longitudinal evidence from the established populations for epidemiologic studies of the elderly. American journal of public health, 89(9), 1346-1352.
  83. Rapp, M. A., Dahlman, K., Sano, M., Grossman, H. T., Haroutunian, V., Gorman, J. M. (2005). Neuropsychological differences between late-onset and recurrent geriatric major depression. American Journal of Psychiatry, 162(4), 691-698.
  84. Rikli, R. E., Jones, C. J. (2013). Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years. The Gerontologist, 53(2), 255-267.
  85. Rowe, J. W., Kahn, R. L. (1997). Successful aging. The gerontologist, 37(4), 433-440.
  86. Sajin, N. B., Dahlan, A., Ibrahim, S. A. S. (2016). Quality of life and leisure participation amongst malay older people in the institution. Procedia-Social and Behavioral Sciences, 234, 83-89.
  87. Schaie, K. W. (1989). The hazards of cognitive aging. The Gerontologist, 29(4), 484-493.
  88. Stineman, M. G., Streim, J. E., Pan, Q., Kurichi, J. E., Rose, S. M. S. F., Xie, D. (2014). Activity limitation stages empirically derived for activities of daily living (ADL) and instrumental ADL in the US adult community-dwelling medicare population. Pm r, 6(11), 976-987. doi: 10.1016/j.pmrj.2014.05.001
  89. Takashima, N., Miura, K., Hozawa, A., Okamura, T., Hayakawa, T., Okuda, N., ... NIPPON DATA80 Research Group. (2010). Cigarette smoking in middle age and a long-term risk of impaired activities of daily living: NIPPON DATA80. Nicotine Tobacco Research, 12(9), 944-949.
  90. Walker, L. O., Avant, K. C. (1995). Concept development. Walker LO, Avant KC. Strategies for theory construction in nursing. 3rd ed. Norwalk: Appleton Lange, 35-78.
  91. Wang, H. C., Li, C. R., Lo, C., Chiao, C. Y., Hsiao, C. Y., Wu, H. S., ... Liao, W. C. (2019). Effect of social support on changes in instrumental activities of daily living in older adults: A national population-based longitudinal study. International Journal of Gerontology, 13(1), 17-22.
  92. Wang, S., Li, L. Z., Zhang, J., Rehkopf, D. H. (2021). Leisure time activities and biomarkers of chronic stress: The mediating roles of alcohol consumption and smoking. Scandinavian Journal of Public Health, 1403494820987461.
  93. WHO(2018).Disability and health.2020年5月取自https://www.who.int/news-room/fact-sheets/detail/disability-and-health
  94. Zimmer, Z., Martin, L. G., Jones, B. L., Nagin, D. S. (2014). Examining late-life functional limitation trajectories and their associations with underlying onset, recovery, and mortality. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 69(2), 275-286.