臺灣長者身體功能變化與隨時間改變的累積壓力生活事件之關係： 使用多階層成長模型分析

Abstract

隨著醫療品質的不斷提升，全球進入高齡化社會，長者的身體功能成為全球公共衛生的重要議題。身體功能是指維持獨立日常生活所需具備的能力，如：洗澡、步行、上下樓梯等，以及不影響日常生活但會影響生活品質的能力，如：購物、做家事等工具性日常生活活動(Garber et al., 2010)。部分學者提出，身體功能會受到所經歷的各種壓力生活事件(Stress life event)而有所改變及影響如：關係破裂、喪親之痛和身體功能呈現負相關，而婚姻、新工作等則呈現正相關(Cleland et al., 2016)，本文欲探討長者經歷之隨時間改變的累積壓力生活事件以及隨著時間的變化，與身體功能的變化是否有關係。 本研究目的有：(1)探討臺灣長者身體功能變化之軌跡類型；(2)了解臺灣長者隨時間改變的累積壓力生活事件對於身體功能變化的影響；(3)再納入控制變項後，臺灣長者隨時間改變的累積壓力生活事件對於身體功能變化的影響是否仍存在；(4)討論個人特質是否會影響身體功能變化；以及(5)討論個人特質是否會影響隨時間改變的累積壓力生活事件對於身體功能變化的影響。 本研究使用中央研究院所釋出之家庭動態資料庫(PSFD)，採用2016、2018、2020以及2022共四波追蹤資料，目標對象為臺灣60歲以上長者(1956年前出生者)，最終樣本數共有992人，共計有3590筆資料。本研究使用SPSS以及HLM8.2等程式，進行多階層成長模型，以了解不同層級變項對於身體功能之影響。 結果如下，時間以及長者所經歷之隨時間改變的累積壓力生活事件，皆與長者身體功能分數呈負相關(time:-0.63,SLE:-0.41)，納入控制變項(隨時間變化的憂鬱情緒)後，時間與隨時間改變的累積壓力生活事件的影響仍然存在，顯著影響身體功能。若再考慮個人特質(性別、教育程度、居住地以及年齡別)後，居住地與教育程度能影響最初(2016年)之身體功能，且能調節時間對於身體功能之影響。 結論：根據本研究結果可知，時間將會影響身體功能變化，其中又以居住於六都以及高教育程度能減緩時間對於身體功能之惡化。而隨時間改變的累積壓力生活事件有別於以往較為主觀之測量方式(憂鬱情緒等)，可作為身體功能變化的客觀預測因子，透過了解長者經歷之隨時間改變的累積壓力生活事件數量以及種類，可進一步預測身體功能變化趨勢，提早進行介入措施，延緩身體功能之惡化。

With the continuous improvement in healthcare quality and the global trend towards an aging society, the physical function of elderly individuals has become a critical issue in global public health. Physical function refers to the ability to maintain independent daily living activities such as bathing, walking, and climbing stairs, as well as instrumental activities that impact quality of life but not daily functioning, such as shopping and household chores (Garber et al., 2010). Some scholars suggest that physical function may be influenced by various stressful life events, with negative correlations observed with events like relationship breakdowns and bereavement, and positive correlations with events like marriage and starting a new job (Cleland et al., 2016). This study aims to investigate whether changes in cumulative stressful life events over time among elderly individuals in Taiwan are associated with changes in their physical function. The objectives of this research are: (1) to explore trajectories of physical function changes among elderly in Taiwan; (2) to understand the impact of cumulative stressful life events over time on changes in physical function among Taiwanese elderly; (3) to examine whether the impact of cumulative stressful life events on changes in physical function persists after controlling for variables; (4) to discuss the influence of individual characteristics on changes in physical function; and (5) to investigate whether individual characteristics moderate the relationship between changes in cumulative stressful life events over time and changes in physical function. This study utilized data from the Panel Study of Family Dynamics (PSFD) released by the Academia Sinica, covering four waves of data from 2016, 2018, 2020, and 2022. The study focused on Taiwanese individuals aged 60 and above (born before 1956), resulting in a final sample size of 992 individuals with a total of 3,590 data points. Multilevel growth modeling was conducted using software such as SPSS and HLM8.2 to understand the influence of different hierarchical variables on physical function. Results indicate that both time and cumulative stressful life events experienced by elderly individuals over time are negatively correlated with their physical function scores (time: -0.63, SLE: -0.41). Even after controlling for variables such as time-varying depressive symptoms, the effects of time and cumulative stressful life events on physical function remain significant. Considering individual characteristics (gender, education level, place of residence, and age group), place of residence and education level were found to influence initial (2016) physical function and moderate the effects of time on physical function. Conclusion: According to the study findings, time significantly influences changes in physical function, with residence in metropolitan areas and higher education levels attenuating the deterioration of physical function over time. Cumulative stressful life events experienced over time, different from subjective measures like depressive symptoms, serve as objective predictors of changes in physical function. Understanding the quantity and types of cumulative stressful life events experienced by elderly individuals can further predict trends in physical function changes, enabling early intervention measures to delay physical function decline.