臺灣博碩士論文加值系統

背景：
過去研究對於不同居住安排的死亡風險尚未有一致定論，有研究認為老人獨居相對於與家人同住者有較高的死亡風險，但有些研究持相反意見，認為獨居相對於與配偶同住的死亡風險無顯著差異；甚至，有研究發現獨居相較於只與子女居住和居住在安養機構，有較低的死亡風險。此外，居住安排會隨著老人本身或突發事件而改變，而過去研究鮮少探討居住安排改變對死亡的影響。

目的：
本研究旨在探討：(1).台灣地區老人獨居、只與配偶同住和只與子女同住等居住安排類型，相較於與配偶子女同住者是否有死亡風險差異？以及(2).居住安排改變者相較於維持原居住安排者是否有死亡風險的差異？

材料與方法：
使用國民健康局「台灣地區老人保健與生活問題長期追蹤調查」資料，選取2,431位於1989年及1993年皆存活的60歲以上老人為研究觀察對象。居住安排分為：獨居、只與配偶、只與子女、與配偶子女四類，共變項為年齡、性別、教育程度、年所得、起始健康狀況（日常生活活動能力、工具性日常生活功能、自評健康、重大疾病罹病數）以及1989年至1993年間經濟狀況的改變與健康狀況的改變。利用羅吉斯迴歸分析居住安排在1989至1993年間維持不變與改變者，其在1996年的死亡狀態是否具有差異。

結果：
在1989-1993年間居住安排維持不變者，在未考慮經濟狀況改變及健康狀況改變的情況下，只與子女同住者相較於與配偶子女同住者會有較高的死亡風險，勝算比為1.52( 95% CI＝1.03-2.23)。其中男性只與子女同住者相較於與配偶子女同住者，其死亡的勝算比為1.88(95% CI＝1.11-3.18)；而女性不論是獨居、只與配偶同住或只與子女同住者相較於與配偶子女同住，其死亡的勝算比皆沒有顯著差異。
但若考慮經濟狀況改變及健康狀況改變時，獨居、只與配偶同住和只與子女同住相較於與配偶子女同住，其死亡的勝算比都沒有顯著差異，OR分別為1.30(95% CI＝0.69-2.45)、0.85(95 %CI＝0.50-1.44)及1.38(95% CI＝0.94-2.04)，且男、女性別均呈現一致結果。
在1989-1993年間居住安排改變者相對於不變者，其死亡的勝算比為1.26(95% CI＝0.93-1.71)。男性居住安排改變者相較於居住安排不變者，其OR為1.13(95% CI＝0.76-1.68)，女性則為1.45(95% CI＝0.90-2.35），但皆未達統計顯著差異。
將居住安排改變類型加以細分下，居住安排在1989-1993年間改變者中，從獨居轉為非獨居、從只與子女同住轉為其他居住安排形式、以及從與配偶子女同住轉為其他居住安排形式者，相對於維持原居住安排者，其勝算比都沒有顯著差異。但是，若居住安排從只與配偶同住轉為獨居，其死亡的勝算比是維持只與配偶同住者的6.4倍(95% CI＝1.74-23.52)，即使考慮經濟狀況改變和健康狀況改變，從只與配偶同住轉為獨居者其死亡風險依然顯著高於維持只與配偶同住者OR=7.82（95% CI＝1.91-32.04)。

結論：
雖然健康狀況變差是影響老人是否死亡的關鍵因素，但居住安排與死亡風險之間，亦有顯著的關連性。本研究發現男性只與子女居住相對於與配偶子女同住有顯著較高的死亡風險。此外，從只與配偶同住轉為獨居的歷程，相對於維持只與配偶同住者亦有較高的死亡風險。
因此未來研究宜針對男性老人喪偶後的生活狀況多加以關注探討，而如何讓原先只與配偶同住的老人在失去配偶後能在短期內適應獨居生活，也是未來值得努力的方向。

Background:
A number of studies have examined the relationship of living arrangements and mortality risk for the elderly but their conclusions are inconsistent. Some studies reported those living alone were at higher risk of death than those living with spouse while some indicated that there were no significant mortality differences between those living alone and those living with spouse. Furthermore, a few studies showed that living alone had even lower mortality risk than those living with children (without a spouse) and those living in an institution. In fact, living arrangement is dynamic during life course and several factors may cause the shifts of living arrangement. Nevertheless, there are only a very few researches exploring the association between the changes of living arrangements and mortality.
Objective：
This study aims to investigate two questions: first, is the mortality risk of those elderly people living with spouse and children lower than the mortality risks of those living alone, those living with spouse only and those living with children only? And second, is the mortality risk of those elderly people without any changes in living arrangement lower than the mortality risks of those with changes?
Method：
A total of 2,431 elderly people who 60 years and older living in year 1993 were followed. Data in year 1989, 1993 and 1996 were obtained from the “Survey of health and living status of the elderly in Taiwan.”dataset conducting by the Bureau of Health Promotion, Department of Health. Living arrangements divided into four groups: living alone, with spouse, with children, and with spouse and children. The covariates were age, sex, education, yearly income, baseline health status (including activity of daily living, instrumental activity of daily living, self-rated health, number of serious illnesses), and changed of income condition and changed of health status between 1989 and 1993. Logistic regression model was used to examine whether different living arrangement associated with mortality among elderly people.
Result:
For the elderly people who remained unchanged in living arrangements between 1989 and 1993, we found that those living with children had higher mortality risk than those living with spouse and children .The odds ratio (OR) was 1.52 (95% C.I.=1.03 - 2.23) before adjusting changed of income condition and changed of health status between 1989 and 1993. In addition, elderly men living with children had higher risk of death than elderly men living with spouse and children(OR=1.88,95%CI =1.11-3.18). However, no association was found of living arrangements and mortality among elderly women.
Nevertheless, after adjusting changed of income condition and changed of health status between 1989 and 1993, the relationship between living arrangement and mortality for men disappeared. We found those living alone, those living with spouse and those living with children all did not have higher mortality risk than those living with spouse and children. The odd ratios were 1.30(95% CI＝0.69-2.45),0.85(95%CI＝0.50-1.44),1.38(95% CI＝0.94-2.04 ) and the relationship between living arrangement and mortality did not have an interaction with sex.
Overall, mortality differences according to the stability of living arrangement between 1989 and 1993 were not significant, with an OR=1.26(95%CI= 0.93- 1.71). The situation was the same when we controlled sex variable. But it was some different when we explicitly distinguished the routes of changes of living arrangement. Those who with living arrangement changed from living with spouse to living alone had higher mortality risk, with an OR=6.4 (95%CI =1.74 - 23.52). The difference was still significant when we controlled covariates – the changes of income and health status between 1989 and 1993.
Conclusions:
Though health condition is the main cause of mortality risk, the mortality of older persons is still affected by living arrangement, especially for men. In our study, widowers had highest mortality risk no matter they were living with children or not. Besides, when a man changed his living arrangement from living with spouse to living alone, his mortality risk would be higher. Therefore, we should pay more attention to the study of life style of widowers and may try to empower them through chore training and care giving.

第一章　前言 1
第一節　研究背景與目的 1
第二節　章節安排 3
第二章　文獻回顧 4
第一節　老人居住安排分布 4
一、各國老人居住安排分布 4
二、台灣老人居住安排分布 5
三、老人居住安排選擇 6
四、居住安排改變相關模型 8
第二節　居住安排對老人健康結果影響之可能機轉 10
第三節　居住安排與死亡之相關實證研究 13
一、居住安排與死亡之相關實證研究 13
二、居住安排改變與死亡之相關實證研究 18
第四節 文獻小結與研究問題假設 21
第三章　研究方法 24
第一節　資料來源與研究對象 24
第二節　變項操作定義 25
第三節　研究架構 31
第四節　統計分析方法 32
第四章　研究結果 34
第一節　描述性統計分析 34
第二節　雙變項分析 45
第三節　多變項分析 49
第五章　討論 64
第一節 主要結果討論 64
第二節 研究限制 70
第三節 結論與建議 70
參考文獻 78
附錄一　1989年原始問卷 81
附錄二　親屬關係及社會支持網代號表 84

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