與子女同住是否降低老人失能風險－十八年追蹤研究的發現

Abstract

背景：與子女同住是臺灣老人最為常見的居住安排，臺灣老人最大宗的理想居住安排亦為與子女同住。過去普遍認為老年人與子女同住可以藉由子女的社會支持增進老年人的健康，但亦有研究支持與子女同住會使老年人的健康惡化，故本研究希望了解在臺灣的背景脈絡下，居住安排(特別是與子女同住)是否會增進老年人的健康。 目標：探討臺灣地區老年人之居住安排與居住安排變化是否會影響失能。 方法：本研究利用1989年開始之「臺灣地區老人保健與生活調查」，歷時十八年之長期追蹤資料，失能狀態為二元依變項，以洗澡是否感到困難進行判定。根據以往文獻，選取重要之控制變項，包含性別、年齡、教育程度、經濟資源、居住地、婚姻狀態、慢性病狀態以及居住安排。分別依同期關聯性以及時序之關聯性進行分析，本文以長期追蹤資料分析方法中的羅吉斯回歸進行分析。 結果：在同期失能狀態與居住安排關聯性之分析當中，「與子女同住」以及「其他居住安排」等兩種居住安排，兩者之失能風險皆較「獨居」為高。而在時序關係(當期失能狀態(t)與前期居住安排(t-1)及前後期居住安排變化(△)之關聯性)之分析當中，在控制了前期失能狀態下，前期屬於「其他居住安排」相較於前期屬於「獨居」，當期失能風險較高，前後期居住安排變更成「與子女同住」者相較於居住安排未改變者，其失能之風險較小。 結論：雖過去文獻在與子女同住之居住安排影響老年人的健康效果上有不同的見解，但在臺灣脈絡的實證研究認為，前期與子女同住相較於獨居其失能風險無明顯差異，且老年人短期內若轉換居住安排為與子女同住，其失能風險會降低。

Backgrounds: The ideal and prevalent living arrangement among Taiwanese elderly is living with his or her children. Cohabitation with children would improve the health of the elderly through children's social support, but researches also found out the negative cohabitation effect. The purpose of this study is to understand whether corresidence with children influences the disability of the elderly in the context of Taiwan. Method: Data comes from the survey of Taiwan Longitudinal Study on Ageing. The dataset consists data of six waves for 18 years. This paper presents a random effect model for the analysis of serial responses of disability status provided by a panel of study participants.Each subject’s serial responses are assumed to arise from a logistic model, but with regression coefficients that vary between subjects. A dynamic panel model was used to estimate the effect of living arrangement on disability among Taiwanese Elderly. Result: The paper describes and analyzes research on the dynamics of disability and living arrangement (including the effect of dynamics on parameter estimates, implications for child effect and non-child effect). The disabled risk is higher for those who corresided with children than those who lived alone, and so was other living arrangement (compared to lived alone). When analyze the lagged variable of living arrangement, the disabled risk is higher for other living arrangement, while the disabled risk for those who corresided with children is no different from those who lived alone. Furthermore, the diabled risk is lower for those who changed his living arrangement from living apart to corresiding with children, compare to those who didn’t change his living arrangement. Conclusion: Previous studies found inconsistent corresidence effect. In the context of Taiwan, this paper shows that in lagged living arrangement, there is no difference in the risk of disability between corresidence and living alone. And it is discovered that change in living arrangement (to cohabitation with children) has lower risk of disability, which means short-term change in living arrangement (other than long-term stable libing arrangement) still has impact on the disability among the elderly.