探討台灣年長者社會支持對工具性日常生活功能改變之影響

Effectiveness of social support on the change of instrumental activities of daily living function among the elderly in Taiwan

莊雅貴(Ya-Guei Chaung)

指導教授 ： 李 淑 杏 教授 ； 廖 玟 君 教授

中山醫學大學/醫學院/護理研究所/碩士(2015年)

https://doi.org/10.6834/CSMU.2015.00077

摘要

前言：台灣人口因死亡率降低、平均餘命延長而使得高齡者人口比率逐年上升，老化的社會型態也使得醫療保健支出提高，如何減緩老化的失能而讓高齡者健康的活著成為重要的議題。過去許多橫斷性研究發現社會支持能減緩失能速度，然縱貫性之資料卻少見。本研究特將社會支持以得到性(Received)及給予性(Given) 分別含工具性及情緒性之分類及社會參與、擔任志工等，進一步以縱貫性資料探討社會支持對於年長者其工具性日常生活功能（instrumental activities of daily living function；IADL）之影響。
方法：本研究採用長期追蹤資料研究設計，使用衛生福利部國民健康署『台灣地區老年身心社會生活狀況長期追蹤調查』之2003年和2007年問卷調查資料。以2003年60歲以上其IADL正常之年長者及2007年60歲以上之年長者為研究樣本。自變項為社會支持，包括得到性工具性及情緒性社會支持、給予性工具性及情緒性社會支持、社會參與；依變項為工具性日常生活功能，包括購物及使用電話；控制變項為基本人口學特性(年齡、婚姻、同住狀態、教育)、生理(慢性疾病、身體及活動功能)和心理(憂鬱、認知功能)相關因素。資料分析採用SPSS/PC 18.0版統計套裝軟體整理與分析，以描述性統計、卡方檢定及邏輯斯迴歸分析社會支持對年長者工具性日常生活功能之影響。
結果：研究人數共2600人，平均年齡為71歲，社會支持與IADL變化影響在卡方檢定分析中，男性在有得到性工具性社會支持(P=0.015)、給予性工具性社會支持(P=0.001)、得到性情緒性社會支持(P=0.002)、社會參與(P=0.022)對IADL功能有顯著的差異；女性則是有給予性工具性社會支持(P=0.011)對IADL功能有顯著的差異。但經多變項分析後發現男性部分社會參與對死亡有顯著的差異，女性則在皆無顯著的差異。死亡是更嚴重的失能，在經多變項迴歸分析發現社會參與與對IADL功能具有著保護效果的存在，而社會支持未有顯著差異。
結論：社會參與對年長者IADL功能有保護效果，而年長者在晚年生活中，年齡本身就影響著身體及活動功能的退化，在未來健康照護規劃時應考量生理、心理等面向再依不同教育程度給予適合的體適能教導來維持身體及活動功能，提升年長族群的自主性與獨立性。透過積極社會參與，培養退休後社會參與的知能，才能提升高齡族群成功老化。

關鍵字

社會支持 ； 工具性日常生活功能 ； 年長者

並列摘要

Introduction: Due to improvements in healthcare, there have been increases in life expectancy and changes in mortality in Taiwan, and thus the ratio of elderly populations to younger populations has increased yearly. With the increase in life expectancy, the goals of healthcare move beyond extending life to improving the quality of life in elderly. Slowing the aging process and reducing disabilities in the elderly population in order that they can live happier, healthier, and more active lives have become important issues. Cross-sectional studies have found social support to be of benefit to this population, though those studies have not clearly defined social support. This study investigates the effect of emotional and instrumental social support, including both given and received, on daily living function in older people.
Methods: This long-term longitudinal used data obtained from the Department of National Health and Welfare Department of Health’s 2003 and 2007 "Survey of Health and Living Status of the Middle Aged and Elderly People in Taiwan,” which contains question items from the instrumental activities of daily living function (IADL). We collected data on the kinds of support the elderly people over 60 years old give and receive and the various indicators of daily living function in 2003 and 2007. Our independent social support variables included access to instrumental and emotional social support the elderly would receive and instrumental and emotional social support they would give though social participation. Our dependent variables were instrumental activities of daily living function, including shopping and use the phone. In our logistic regression and chi-square analysis, we controlled for basic demographic characteristics, including age, marital status, living status, education, physical status, including chronic illness, physical function and activity and psychological status, including depression and cognitive function. All statistical operations were performed using SPSS / PC 18.0 statistical software package.
Results: We analyzed the data of 2,600 people (average 71 years old). Our logistic analysis found that in males the follow had significant impact on IADL: receipt of instrumental social support (P = 0.015), giving instrumental social support (P = 0.001), receipt of emotional social support (P = 0.002), and social participation (P = 0.022). For the females, a significant impact on IADL function was found in giving instrumental social support (P = 0.011). Multivariate regression analysis showed that social participation as a function of the IADL had a protective effect on death, the most severe disability, but found no significant differences for other forms of social support.
Conclusion: Social participation had a protective effect on IADL functioning. In older people, increased age brings about the degradation of physical function and activity. Future health care planning should take into consideration the physical and psychological state as well education level of the elderly to help them remain physically fit and active and help them remain as autonomous and independent as possible. Senior citizen’s active participation in society, cultural knowledge, and ability to participate in a retirement communities are important to successful aging.

並列關鍵字

social support ； instrumental activities of daily living ； elderly

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