臺灣老年人生活品質的影響因子

Abstract

介紹 隨著世界60歲以上老年人口快速的成長，生活品質在老年族群已成為重要議題，本研究是臺灣第一個使用CASP-19問卷來測量生活品質的大型研究。 目的 (1)了解臺灣老年人生活品質的影響因子有哪些，(2)檢定健康狀態、社會資本與生活品質間相互之關聯為何。 方法與材料 計畫本身是以2010年台北仁愛醫院老人健檢為基礎、前瞻性的世代研究，但本研究以橫斷法的方式來測量影響因子與老人生活品質間的關係。研究族群從3680位參加仁愛醫院老人健檢的民眾中選出697位參與者並進行訪談與填寫問卷。本研究主要想要了解的結果為老人的生活品質，預測變項包含基本人口學變項、健康的危險因子與社會資本。我們以低於CASP-19平均值39分來代表較差的生活品質，同時以性別分層來了解不同性別對生活品質的影響。剖面分析檢定變項在CASP四個區域有沒有差異，平行性檢定是來測量變項間的差別有無一致，若不存在差異，平坦性分析再來測量變項間的CASP分數有無重合。我們同時使用結構方程模行測量健康狀態、社會資本與生活品質間的相關性。 結果 綜合分析發現，年齡較大(aOR:1.08)、女性(aOR:1.97)、沒有國中畢業(aOR:2.73)、收入勉強夠用(aOR:2.90)、自覺現在機會(aOR:4.50)與滿足感(aOR:2.11)比年輕時少、不甚滿意的住家環境(aOR:1.68)、沒有親近關係(aOR:7.88)、沒有家人 (aOR:5.33)與沒有朋友者(aOR:3.76)，生活品質得分顯著較低。在剖面分析中發現，所有變項在CASP四個區域皆有差異，同時性別不存在交互作用(p=0.0908)。另外結構方程模型檢定出，健康狀態影響生活品質是經由社會資本的中介作用。 結論 在臺灣老人族群中，健康需經由社會資本做為中介，間接影響生活品質。此外，在諸多變項中，社會資本對生活品質顯示很強的影響力。

Introduction Those aged 60 and over are now the fastest growing population in the world. Quality of life (QOL) is an important part of the wellbeing of the senior citizens. This study is one of the very few large-scaled reports using the CASP-19 in Taiwanese population. Objective First, we aimed to study factors associated with QOL among community dwelling elderly in Taiwan. Second, we aimed to examine the associated relationships between health status, social capital, and QOL in elderly. Materials and Methods This study is the cross-sectional part of a hospital-based, prospective cohort study in Taipei City, Taiwan in 2010. Our sample included 697 elders from the 3680 examinees of the free annual Senior Citizens Health Examination. Participants were interviewed with a detailed questionnaire. The main outcome was QOL, predictor variables included socio-demographic characteristics, health risk factors and social capital. We defined a CASP-19 score below 39 (mean) as poor QOL. We stratify the sample by gender. Profile analysis comprised of the tests of difference among subgroups, parallelism for interaction among subgroups, and flatness for difference the domain scores of the CASP scale. We also assessed relationship among health status, social capital and QOL by using structural equation modeling (SEM). Results In these community-dwelling Taiwanese senior citizens, we observed that advanced age (aOR:1.08), female gender (aOR:1.97), education under junior high school (aOR:2.73), barely enough income (aOR:2.90), having fewer opportunities (aOR:4.50) and satisfactions (aOR:2.11) than 30s, lived in acceptable environment (aOR:1.68), having none intimate relationships (aOR:7.88), having none family relationships (aOR:5.33), having none friends (aOR:3.76) were all associated with QOL. QOL were mainly associated age, gender, education, economic status, opportunities and satisfactions, living environment, intimate relationships. Males and females did not differ in most predictors. In the profile analysis, different subgroups differed in four domains, parallelism was observed among gender (p=0.0908). In the SEM, health status affect QOL only through social capital. Conclusion Among community-dwelling older people in Taiwan, health should pass through social capital as a intermediate and indirect influence on QOL. In addition to other risk factors, social capital are strong indicator of people’s general well-being.