在地老化實踐、外在連續性與都市老人生活品質研究-以台北市為例

Abstract

在地老化是1980 年代以來各國普世的老人照護目標，被視為提升老年生活品質的關鍵。然而，目前缺少探討在地老化整體實踐如何影響老人生活品質的研究；是否有其他因素存在於在地老化實踐的影響過程中，也缺乏討論。據文獻探討，老人於日常生活中保有行為慣習的連續性，亦可能為影響生活品質之因素。因此本研究立基於環境老年學的環境壓力理論，據在地老化的定義嘗試以居家安全性、生活自主性、社區環境高齡友善性三項指標作為在地老化實踐的測量。同時融合連續理論中的外在連續性，探索上述變項對都市長者生活品質的影響效果。 透過台北市253 位60 歲以上長者的有效回覆，藉統計軟體SPSS 與AMOS進行多元迴歸及中介效果路徑分析。整體來說研究發現居家安全、生活自主、社區環境友善性皆能提升生活品質，當中又以後兩項實踐的影響更為重要。其次，長者的人際穩定性與活動連續性亦能提升其生活品質，且其不僅有直接效果，亦在生活自主與社區環境友善對生活品質的影響具有部份中介效果。 在地老化因失能照護與去機構化理念而起，使政策較關注生理照顧層面的服務。然而，若欲展現在地老化積極意涵，本研究則認為勿僅止滿足於長者在地居住而非送往機構的事實，應關注其居家安全、生活自主、社區高齡友善環境的落實。重要的是，都市長者的外在連續性應被看見，協助其與熟悉人事物和社區環境保有長期且持續的連結，避免長者「雖住在家裡或來回於各種社區式服務之間，卻與在地生活毫無與自身生命經驗連續的關係」。於實務工作中，建議工作者評估社區長者生活品質時，將上述三項在地老化實踐項目納入考量，並於服務方案融入在地或長輩熟悉的相關元素，使其能立基過往的人際關係或活動上適應生活中的新改變。同時，倡議型組織可積極關注長者於都市社區空間上之使用權利／力關係，以落實真正有生活品質的在地老化。

“Aging in place” has long been a popular and desirable term to improve quality of life (QOL) among older adults. Yet most existing studies only focus on certain aspects instead of viewing aging in place inclusively from its three elemental definitions: being safe at home, maintaining autonomy, and enjoying aging-friendly community. Furthermore, less is known about how continuity of daily lives potentially affects older adults’ QOL. Integrating the Environmental Press Theory and the Continuity Theory, this study evaluates how aging in place elements and external continuity of city dwelling older adults combine to their quality of lives. 253 adults aged 60 and above were recruited. The sample was not representative of community-dwelling older adults in Taipei city. A structed questionnaire was done by either paper-and-pencil or an online survey. Results found that, firstly, home safety, autonomy and aging-friendly community all positively affect QOL, with the two latter elements having stronger effect. Secondly, stability of personal relationship and activity continuity not only show strong effect towards QOL but also play as mediators between autonomy, aging-friendly community and QOL. This study urges that to put aging in place into a more active practice, policy makers and social workers should not only evaluate the situation of home safety, autonomy and aging-friendly community of older adults, but also pay attention to their external continuity which is to keep the long-term relationship with local community and preserve their own daily routines. To meet higher QOL among older adults, related organizations could be more proactive to empower older people to become agents of their own communities and city spaces.