從健康的社會決定因素觀點分析鄰里特徵、身體活動、靜態行為、老化態度和衰弱之關聯性

Abstract

本研究旨在透過健康的社會決定因素觀點，分析鄰里特徵、身體活動、靜態行為、老化態度和生理衰弱、社會衰弱的關聯性，以瞭解實務上能透過哪些介入或資源分配，可以預防高齡者的生理與社會衰弱。本研究為橫斷性設計，研究對象為臺南市之65歲以上、居住於一般社區之高齡者，採立意取樣進行自編問卷之面訪，共計有569份有效樣本。主要運用羅吉斯迴歸、多層次模型進行資料分析。研究結果發現：一、年齡較大、生活費由子女或他人提供、有IADL失能、負向老化態度高者有較高的風險罹患生理衰弱；每月生活費較高、身體活動量較高則對生理衰弱具保護效果。二、女性、獨居、負向老化態度高者有較高的風險罹患社會衰弱；正向老化態度則對社會衰弱具保護效果。三、社會凝聚力會調節老化態度對生理衰弱的影響；城鄉城級則會調節性別、身體活動、靜態行為對社會衰弱的影響。四、主觀鄰里環境感受越好，能提高身體活動、靜態行為以及正向老化態度，或降低負面老化態度，並進一步降低生理及社會衰弱。因應高齡社會，建置高品質之高齡友善實體環境、建立高齡友善的價值文化、宣導及教育大眾具備正向的老化態度，皆是政府可努力之方向。

This study aims to examine the relationship among neighborhood characteristics, physical activity, sedentary behaviors, attitudes toward aging, and both physical and social frailty through the lens of the social determinants of health. The objective is to identify practical interventions and resource allocation strategies that may prevent physical and social frailty among older adults. This study employed a cross-sectional design, targeting older adults aged 65 and above residing in community settings in Tainan City, Taiwan. Using purposive sampling, 569 valid responses were collected via face-to-face interviews based on a self-developed questionnaire. Logistic regression and multilevel modeling were employed for data analysis. The findings were as follows: (1) Older age, financial support from children or others, IADL disability, and higher levels of negative attitudes toward aging were associated with an increased risk of physical frailty. On the other hand, higher monthly living expenses and greater levels of physical activity were protective factors. (2) Being female, living alone, and holding negative attitudes toward aging were significantly associated with increased risk of social frailty, while positive attitudes served as a protective factor. (3) Social cohesion moderated the relationship between attitudes toward aging and physical frailty. Additionally, the effects of gender, physical activity, and sedentary behavior on social frailty were moderated by urban–rural classification. (4) Favorable perceptions of neighborhood environment positively influenced physical activity, sedentary behaviors, and positive attitudes toward aging, and negatively influenced negative attitudes toward aging, thereby reducing both forms of frailty. In response to an aging society, governmental efforts should focus on developing high-quality age-friendly physical environments, fostering cultural values that promote positive aging, and enhancing public awareness and education regarding aging-related issues.