臺灣博碩士論文加值系統

人口老化是世界性的趨勢，台灣亦不例外。老人乃罹患慢性疾病的高危險群，且多屬於需長期休養的慢性病；人口老化對醫療保健以及長期照護體系必然產生重大的衝擊。因此，若能瞭解老人及其家屬對於健康相關生活品質的情形，在政策考量上會更周延。
本研究目的主要是探討台灣北部地區的社區老人及其家屬的健康相關生活品質及其影響因素。本研究以台灣北部七縣市的社區老人及其家屬為研究對象，共面訪575對老人及其家屬。主要結果顯示：
一 受訪社區老人及其家屬健康相關生活品質（世界衛生組織簡明版問卷），平均總分各為53.16分、56.02分（四個範疇總計80分），屬於中上程度。就老人及其家屬健康相關生活品質四個範疇而言，老人主要以社會範疇最為滿意，家屬以生理範疇最滿意，老人及其家屬均以心理範疇最不滿意。
二 受訪社區老人及家屬健康效用量測，自評健康分數平均總分各為65.63分、74.38分，而時間替代法中社區老人及其家屬願意替換者，健康效用值各為0.554（N=132）、0.221（N=123）。
三 社區老人整體範疇之健康相關生活品質，經由逐步迴歸分析，重要的預測變項「日常活動能力」、「自覺快樂程度」、「自評健康分數」等，可解釋整體迴歸模式總變異量為57.4%。
四 家屬整體範疇健康相關生活品質，經由逐步迴歸分析，重要預測變項「自覺健康狀況」、「自覺快樂程度」、「自評健康分數」等，可解釋整體迴歸模式總變異量為57.0%。
五「自覺快樂程度」為社區老人及其家屬各範疇的迴歸模式中共同出現的重要預測變項，亦顯示心情對於生活品質具有重要影響。
本研究結果可以瞭解台灣北部社區老人及其家屬的健康相關生活品質不錯，但是分別受到不同因素的影響，可以作為政府相關部門提升生活品質參考。

Aging is a worldwide trend, and this phenomenon could also be observed in Taiwan. Elderly people have high risk of chronic diseases, and they will need long-term recuperation if they suffer from these diseases. Therefore, the systems of health care and long-term nursing would be heavily struck when the population structure shifts. We believe that the government would have a better policy if we understand more about the health-related life quality of the old and their families.
The objective of this study is exploring the health-related life qualities and other influential factors of the community elders and their family in northern Taiwan. We interviewed 575 community elders and their families in 7 counties / cities in this area, and we found:
1.The mean score of health-related quality of life (WHOQOL-BREF questionnaire) of the participating community elders and their families were 53.16 and 56.02 respectively (total 4 sections added up to 80). Both were above average. Regarding all four sections, the elders were most satisfied with the social one, and their families scored the physiological condition as the highest. Both the elders and their families dissatisfied with the psychological condition section.
2.The mean score of health utility measurement and self-reported physical condition of the participating community elders and their families were 65.63 and 74.38. We also investigated a Time Trade-Off (TTO) question, and we found that the health utility value of the elders and their families who would like to trade off were 0.554 (N=132) and 0.221 (n=123).
3.We analyzed these data by stepwise regression, the best independent variables of integrated section in health-related quality of life of these community elders were: abilities in daily activity, self-reported happiness level, and the score of self-reported physical condition. The reasonable variance of the whole regression model was 57.4%.
4.We also analyzed other data from the families by the same criteria, and we found that the best independent variables of integrated section in health-related quality of life of these people were: self-reported physical condition, self-reported happiness level, and the score of self-reported physical condition. The reasonable variance of the whole regression model was 57.0%.
5.The level of self-reported happiness level was the most important independent variable of all because it appeared in both regression model of the community elders and their families. This showed that the mood affected their life quality very well.
This study showed that the health-related life qualities of the community elders and their families who lived in northern Taiwan were good, but affected by different factors. It could help the related authorities to elevate the quality of life of the countryman.

第一章 緒論
第一節 研究動機-----------------------------------------1
第二節 名詞解釋-----------------------------------------4
第二章 文獻探討
第一節 生活品質----------------------------------------5
第二節 影響社區老人及其家屬生活品質之因素--------------10
第三章 研究架構與假設
第一節 社區老人之研究架構------------------------------16
第二節 社區老人之研究假設------------------------------17
第三節 家屬之研究設------------------------------------18
第四節 家屬之研究假設----------------------------------19
第四章 研究方法與工具
第一節 研究對象----------------------------------------20
第二節 研究工具----------------------------------------22
第三節 量表信效度檢定----------------------------------30
第四節 資料收集----------------------------------------32
第五節 資料處理與統計分析------------------------------34
第六節 研究變項操作型定義------------------------------37
第五章 研究結果與分析
第一部分 訪視情形----------------------------------------43
第二部分 社區老人部分
第一節 特質分佈情形------------------------------------44
第二節 生活品質之分佈情形------------------------------47
第三節 健康效用量測之分佈情形--------------------------49
第四節 生活品質影響因素--------------------------------51
第三部分 家屬部分
第一節 特質分佈情形------------------------------------71
第二節 生活品質之分佈情形------------------------------74
第三節 健康效用量測之分佈情形--------------------------76
第四節 生活品質影響因素--------------------------------78
第六章 討論
第一部分 社區老人部分
第一節 特質分佈情形及健康效用量測----------------------103
第二節 基本特質與生活品質相關探討----------------------106
第三節 健康狀況與生活品質相關探討----------------------109
第四節 健康效用量測與生活品質相關探討------------------111
第二部分 家屬部分
第一節 特質分佈情形及健康效用量測----------------------112
第二節 基本特質與生活品質相關探討----------------------115
第三節 照顧老人負擔情形與生活品質相關探討--------------118
第四節 健康狀況與生活品質相關探討----------------------120
第五節 健康效用量測與生活品質相關探討------------------122
第三部分 研究限制與缺失----------------------------------123
第七章 結論與建議
第一節 結論--------------------------------------------124
第二節 建議--------------------------------------------135

中文部分
1.內政部：中華民國八十五年台閩地區老人狀況調查1996。
2.內政部：中華民國八十九年台閩地區老人狀況調查2000。
3.內政部統計處：中華民國九十年台閩地區國民生活狀況調查2001。
4.台灣版世界衛生組織生活品質問卷發展小組. 台灣簡明版世界衛生組織生活品質問卷之發展及使用手冊（第一版），2000。
5.行政院經建會人力規劃處：中華民國台灣地區民國八十七年至一四○年人口推計，台北，1999。
6.林佳儒：家庭照顧者社會支持之研究-以慢性精神分裂病人之照顧為例，陽明大學護理學研究所碩士論文，1990。
7.林佳蓉：老人生活模式滿意研究，國立體育學院體育研究所碩士論文，2001。
8.呂寶靜：老人研究的範疇與理論架構。研考雙月刊 1993；17（2）：37-44。
9.呂文慧：台灣地區人口高齡化的預估與其對醫療費用影響之研究. 政治大學研究所碩士論文，1996。
10.季瑋珠、張玨、胡幼慧等：家庭疾病照顧與婦女角色之研究。中華衛誌1992：11：1-12。。
11.姚開屏：健康相關生活品質概念與測量原理之簡介。http://home.mc.ntu.edu.tw/~cfyu/book1.htm.
12.高森永、等：社區老人與慢性病患對長期照護需求之探討。行政院衛生署八十八年度委託研究計畫報告，1999。
13.徐慧娟、吳淑瓊、江東亮：跌倒對社區老人對健康相關生活品質。中華衛誌1996：15：525-532。
14.梁繼權：生活品質評估。醫學繼續教育1995；5(3)：283-286。
15.陸洛、劉宏文：功能性社會支持與老人整體健康之相關性研究。高學醫學院行為科學研究所，行政院衛生署八十三年委辦業務計畫，計畫編號 DOH83-HP-47。
16.陸洛:中國人幸福感之內涵、測量及相關因素探討。國家科學委員會研究彙刊：人文及社會科學1998;8(1):115-137。
17.郭靜燕：我國老人長期照護保險之可行性研究。陽明大學公共衛生研究所碩士論文，1996。
18.曾淑汝：護理之家老年住民的生活品質及相關因素探討。高雄醫學院護理學研究所碩士論文，1998。
19.陳肇男：台灣老人之年齡增長與生活滿意。人口學刊 2000;21:37-59。
20.陳美光：老人健康生活品質與健康習及社會心理因素關係之探討。台灣大學心理學研究所碩士論文，1998。
21.粱金麗：社區老人生活品質及其相關因素之探討。國立台北護理學院研究所碩士論文，2000。
22.蔡文玲：老人慢性病與失能情況之相關探討。高雄醫學院公共衛生研究所碩士論文，1998。
23.黃璉華：老人生活滿意度相關因素分析研究。護理雜誌 1992；3（4）：37-47。
24.歐美：居家中風病患女性配偶的壓力評估、因應方式與心理健康間相關性及影響因素之探討，國防醫學院護理研究所碩士論文，1992。
25.藍忠孚：機構照護老人之生活品質：健康福祇政策意義。行政院衛生署委託研究計劃，1993。
英文部分
1.Abbey A, Andrews FM. Modeling the psychological determinants of life quality. Social Indicator Research 1985;16:1-34.
2.Abrams MA.Subjective social indicators. Social Trends 1973; 4:35-56.
3.Atchley RC. Selected social and psychological differences between men and women in later life. Journal of Gerontology 1976;31(2):204-11.
4.Batel-Copel LM ,Kornblith A,Batel PC. Do oncologists have an increasing interest in the quality of life of their patients? European Journal of Cancer 1997; 33:29-32.
5.Brody EM. Parent care as a normative family stress. American Psychologist 1976;32(2):117-126.
6.Browne JP.Health-related quality of life studies in urology: conceptual and methological considerations. World Journal of Urology 1999;17:193-198.
7.Campell A.Subjective measures of well-being. American Psychologist 1976;31:117-124.
8.Collins CE,Given BA,Given CW.Interactions with family caregivers of persons with Alzheimer’s disease. Nursing Clinics of North America 1994;29(1):195-207.
9.Day H , Jankey SG.Lessons from the literature: Toward a holistic model of quality of life. In Renwick R et al eds. Quality of Life in Health Promotion and Rehabilitation, 1996, pp39-62.
10.Dickie JR, Ludwig TE, Blauw D.Life satisfaction among institutionalized and non institutionalized older adults. Pshological Reports 1979;44:807-810.
11.Diener E, Diener C. Most people are happy. Psychological Science 1996;7:181-185.
12.Duffy ME, Rossow R, Hermandez M. Correlates of health promotion activities in employed Mexican American Women.Nursing Research 1996;45(1):18-24.
13.Evans RW, Manninen DL, Garrison LP et al. The quality of patients with end-stage renal disease. The New England Journal of medcine 1995;312(9):553-559.
14.Ferrans CE, Powers MJ.Quality of life index: Development and psychometric properties. Advances in Nursing Service 1985;1:15-24.
15.Ferrell BR, Wisdom C, Wenzl C.Quality of life as an outcome variable in the management of cancer pain. Cancer 1989; 63(Suppl): 2321-7.
16.Fry Christine L.Age, Aging, and Culture.In: Binstock Robert H,George Linda K.Handbook of Aging and Social Sciences,4th edition.Academic Press 1996,117-136.
17.Fryback DG, Dasbach EJ, Klein R et al. The Beaver Dam Health Outcomes Study : initial catalog of health —state quality factors. Medical decision Making 1993; 13:89-102.
18.Hanestad BR.Errors of measurement affecting the reliability and validity data acquired from self-assessed quality of life. Scandinavian Journal of the Caring Sciences 1990; 4(1): 29-34.
19.Headey B, Wearing A.Subjective well-being and coping with adversity. Social Indicators Research 1990; 22:327-349.
20.Headey B, Wearing A. Understanding happiness:a theory of subjective well-being. Melbourne: Longman Cheshire, 1992,pp1-226.
21.Katz S. The science of quality of life. Journal of Chronic Diseases 1987; 40:459-463,.
22.Langenhoff BS , Krabbe PF,Wobbes T et al. Quality of life as an outcome measure in surgical oncology.British Journal of Surgery 2001;88(5):643-652.
23.Last JM eds. A Dictionary of Epidemiology. 2nd ed. New York: Oxford University Press, 1988.
24.Lawton MP. A multidimensional view of quality of life in frail elderly. In: Birren JE et al eds. The Concept and Measurement Quality of Life in the Frail Elderly. San Diego: Academic Press, 1991,pp4-23.
25.Liang J.Sex differences in life satisfaction among the elderly. Journal of Gerontology 1982; 37(1): 100-108.
26.Maddox GL, Douglass EB.Self-assessment of Health and Social behavior 1973; 14(10): 87-93.
27.Markides KS, Martin HW.A causal model of life satisfaction among the elderly. Journal of Gerontology 1979; 34:86-93.
28.Meeberg GA.Quality of life: A concept analysis. Journal of Advanced Nursing 1993; 18:32-38.
29.MeMendola WF, Pellegrini RV.Quality of life and coronary artery bypass surgery patients. Social science and Medicine 1979; 13:457-461.
30.Mohide E,Pringle D,Streiner D.A randomized trial of family caregiver support in the home management of dementia. Journal of American Geriatric Society 1990;38(4):446-454.
31.Mount BM, CohenSR.Quality of life in the face of life-threatening illness: What should we be measuring? Current Oncology 1995;2: 121-125.
32.Myers DG, Diener B.Who is happy? Psychological Science 1995; 6:10-15.
33.Newson JT, Schulz R. Social support as a mediator in the relation between functional status and quality of life in older adults. Psychological Ageing 1996; 11:34-44.
34.Palmore E, Luikart C.Health and social factors related to life satisfaction:A longitudinal study of persons aged 46-70. Journal of Health and Social Behavior 1972; 13:68-80.
35.Palmore E, Kivett V. Chang in life satisfaction: A logitudinal study of persons aged 46-70.Journal of Gerontology 1977;32(3):311-316.
36.Patrick DL, Erickson P. Health status and health policy：Allocating resources to health care. New York：Oxford University Press, 1993.
37.Post PN, Stiggelbout AM, Wakker PP. The utility of health states after stroke: a systematic review of the literature.Stroke 2001;32(6):1425-1429.
38.Robinson MD, Johnson JT. Is emotion a stress? Gender stereotypes and the perception of subjective experience. Sex Roles 1997; 36:235-258.
39.Ross LN, Beall GT. Supports for family caregivers: Opportunities for national organization. Patterns of Progress in Aging among National Voluntary Organization 1986;(III):1-16
40.Spreitzer E, Synder EE. Correlates of life satisfaction among the aged.Journal of Gerontology 1974;29(4):454-458.
41.Stuck AE, Arrow HU, Steiner A et al. A trial of annual in-come comprehensive geriatric assessment for elderly people living in the community. The New England Journal of Medicine 1995; 333:1184-1189.
42.United Nations.Population 2002.
43.Tsevat J, Goldman L, Kuntz KM et al. Functional status versus utilities in survivors of myocardianl infarction. Medical Care 1991; 29:1153-1159.
44.Tsevat J,Solzan JG, Kuntz KM et al. Health values of patients infected with human immunodeficiency virus:realtionship to mental health and physical functioning. Medical Care 1996; 34:44-57.
45.Tsevat J, Dawson NV, Wu AW et al. Health values of hospitalized patients 80 years or older. HELP Investigators. Hospitalized Elderly Longitudinal Project. The Journal of the American Medical Association 1998; 279(5):371-375.
46.Torrance GW. Measurement of health state utilities for economic appraisal. Journal of Health Economics 1986;5(1):1-30.
47.The WHOQOL Group. Development of the WHOQOL：Rationale and current status. Internal Journal of Mental Health 1994a; 23（3）：24-56.
48.The WHOQOL Group. The development of the World Health Organization Quality of Life assessment instrument （the WHOQOL）：In Oeley J & Kuyen W eds. Quality of life assessment：international perspectives 1994b, pp41-57.
49.Zhan L. Quality of life: conceptual and measurement issues. Journal of Advanced Nursing 1992; 17(7): 795-800.