Covid-19 期間衰弱與非衰弱社區高齡者休閒活動參與度改變和生活品質的關係

Abstract

研究背景與目的：台灣預計於2025年進入超高齡社會，長者人口佔比逐年上升，隨著平均餘命的增長，WHO於二十世紀初相繼提出活躍老化及健康老化的概念，長者生活品質的議題受到重視，過去研究顯示休閒活動參與會提高生活品質，而衰弱狀況會影響休閒活動的參與，疫情期間長者為避免受到傳染而改變休閒方式，目前對於疫情期間C據點長者休閒活動參與度改變對於生活品質的關係，尚未獲得驗證，因此本研究的目的為探討疫情期間休閒活動參與度改變與生活品質的相關性，並進一步觀察衰弱狀況對於兩者關係的影響。 研究方法：本研究使用陳雅美博士研究團隊與國科會「新冠肺炎下長期照顧服務管制對於使用者及家庭照顧者之影響:運用多元觀點剖析」合作計劃之問卷，該計畫之問卷是以利益取樣的方式，本研究使用參與C據點的長者面訪問卷共237份，使用休閒活動參與度量表，並使用生活品質量表(SF-8)、整合性衰弱指標(MSTQ, Modified SOF TFI QSFS Integrated Frailty Tool)，衡量長者疫情期間休閒活動參與度改變，以及生活品質與衰弱狀況。將休閒活動依參與型態分類為個人與團體兩類，在控制其他變項之後，以複回歸分析比較疫情期間不良個人與團體休閒活動參與度改變與否對於生活品質之差異，並進一步比較衰弱狀況族群。 研究結果：疫情期間，長者增加看電視參與度(22.78%)，而親友見面(52.74%)、團體活動(48.52%)減少，顯示長者有不良休閒活動改變，特別是前衰與衰弱長者的上網活動(p =0.0252)會有顯著的不良改變。雙變量分析顯示，整體長者的不良個人休閒活動參與度改變與整體(r =-0.13, p =0.045)與心理生活品質(r =-0.14, p =0.0327)有顯著相關，迴歸分析結果顯示，不良個人休閒活動參與度改變在整體與前衰與衰弱長者中和整體生活品質有邊際顯著結果(p =0.0958、0.0769)，相反地，不良團體休閒活動改變則對所有生活品質皆無顯著影響。 研究結論：本研究結果發現疫情期間長者的休閒活動朝不良的方向改變。本研究進一步瞭解疫情期間休閒活動變化與生活品質的關係，看到C據點長者以及前衰與衰弱長者的不良個人休閒活動變化與較低的整體生活品質有相關向。過去對休閒活動長期追蹤的研究與本研究相呼應，發現增加及維持高休閒活動參與有助於維持生心理健康。研究結果提供休閒活動改變的實證依據，因此政府未來應更加重視休閒活動對長者的影響。研究還發現，有前衰與衰弱狀況的長者的個人休閒活動變化與整體生活品質相關，顯示前衰與衰弱長者受到較大的影響，儘管本研究團體休閒活動改變對長者生活品質影響不顯著，可能是因為疫情前參與團體活動帶來的長期效益，未來可能會隨著改變時間延長而有不同的結果產生。因此，未來應積極推廣和鼓勵長者參與多元休閒活動，促進社會互動和良好的生活品質。

Background: By 2025, Taiwan is expected to enter a super-aged society, as the proportion of older adults steadily increasing, coupled with the extension of life expectancy, WHO introduced the concept of active aging and healthy aging since the early 20th century. The issue of older adults’ quality of life has received increasing attention. Past studies showed that participation in leisure activities can enhance quality of life, and the frailty will affect engaged in such activities. As the Covid-19 outbreaking, older adults have changed their leisure activity to avoid transmission. Currently, the association of the change of leisure activity on quality of life in older adults among tier c centers has not been verified. Therefore, the purpose of this study is to explore the correlation between changes in leisure activity and quality of life during the pandemic, and also examining how frailty influences this relationship. Method: This study using a questionnaire developed by Dr. Chen’s research team in collaboration with the National Science and Technology Council, named “The Impact of COVID-19 Lockdowns on Long-Term Care Service Users and Their Families: An Investigation from Multiple Perspectives”. The survey was conducted by a purpose sampling method, a total of 237 older adults from tier c centers in this study. The measures of leisure activity participation, as well as the Short Form-8 (SF-8) and the Modified SOF TFI QSFS Integrated Frailty Tool (MSTQ) were used as measurement to assess changes in participation of leisure activity in the questionnaire. Classified by participation type, leisure activities are categorized into individual and group activities. To controlling for other variables, employed with the multiple regression analysis to compare the differences in quality of life based on adverse changes in individual and group leisure activity participation during the pandemic. Additionally, a comparison between frailty status was made. Results: During the pandemic, older adults have increased their television viewing (22.78%) but decreased participation in socializing with friends (52.74%) and group activities (48.52%), indicating adverse changes in their leisure activities. Specifically, internet usage among pre-frail and frail older adults shows significant adverse changes (p =0.0252). Bivariate analysis shows that changes in overall participation in negative personal leisure activities among the older adults are significantly correlated with overall (r =-0.13, p =0.045) and psychological quality of life (r =-0.14, p =0.0327). Then, regression analysis results indicated that the adverse changes in overall participation in leisure activities show marginally significant effects on overall quality of life, as well as on pre-frail and frail individuals (p =0.0958, p =0.0769). In contrast, group leisure activities showed no significant correlation on any aspect of quality of life. Conclusion: The results indicated adverse changes in the leisure activities of older adults during the pandemic. This study further explores the relationship between adverse changes in leisure activities during the pandemic and quality of life. It reveals a tendency where adverse changes in personal leisure activities among older adults, as well as pre-frail and frail individuals, are associated with lower overall quality of life. The follow-up studies on change in leisure activities findings are aligned to the study, indicating that increasing and maintaining high levels of leisure activity participation contribute to mental and physical well-being. The results of the study provide empirical evidence of changes in leisure activities, thus indicating that governments should pay more attention to the impact of leisure activities on older adults in the future. The study also discovered that changes in personal leisure activities among pre-frail and frail individuals were related to overall quality of life, indicating that pre-frail and frail individuals were more affected. Although changes in group leisure activities did not significantly affect the quality of life of the older adults in this study, this might be due to the long-term benefits of participating in group activities before the pandemic. As time progresses, these effects may difference. Therefore, it’s crucial to actively promote and support older adults’ involvement in various leisure activities to maintain social connections and foster a high quality of life.