跳到主要內容

臺灣博碩士論文加值系統

(3.236.124.56) 您好!臺灣時間:2021/07/28 09:36
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

我願授權國圖
: 
twitterline
研究生:張芬娜
研究生(外文):Fan-Na Cheong
論文名稱:社經地位因素與老年人失能軌跡之探討
論文名稱(外文):Socioeconomic Factors and Disability Trajectories among the Elderly
指導教授:藍忠孚藍忠孚引用關係
指導教授(外文):Chung-Fu Lan
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:衛生福利研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:106
中文關鍵詞:老人社經地位失能階層線性模式線性成長模型
外文關鍵詞:elderlysocio-economic factorsSESdisabilitymultilevel analysislinear growth model
相關次數:
  • 被引用被引用:5
  • 點閱點閱:342
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
背景:社經地位因素(socio-economic factors)是影響人口健康重要指標,而隨著人口老化及疾病型態的轉變,越來越多的研究探討SES對於失能之影響,然而大部份相關研究都著重於探討社經地位如何影響失能發生之風險,在針對失能程度改變方面,通常以兩個時間點作測量,未能反映出真正的變化軌跡。另一方面,失能與眾多疾病及其他風險因子有關,部份因子也是死亡的預測因子,有鑑於此,本研究認為有必要進一步探討社經地位對於老年人失能程度及改變之影響,並進一步瞭解哪些因子可削弱社經地位與失能及改變之關係。
目的: 1. 探討社經地位對於老年人失能程度及改變之關係;2.進一步瞭解在加入人口學、健康狀態、社會心理狀態等影響因素後,是否能解釋社經地位與失能程度之關係。
方法:以國民健康局的1993-2003年共四波之「台灣地區中老年身心社會生活狀況長期追蹤調查」資料,以65歲或以上之老年人為研究對象(共2,759人)。社經地位因素以教育程度、職業類別及自覺經濟狀況測量,失能以Nagi、IADL及ADL測量之。本研究以SAS9.2套裝軟體proc mixed進行階層線性模式中的線性成長模型分析。
結果:
一、 社經地位因素與Nagi失能改變情形之關係
1. 教育程度與初始Nagi失能程度沒有相關;但教育程度越低者,Nagi失能速度越快。
2. 職業類別與初始Nagi失能程度沒有相關;但職業階層越高,Nagi失能速度則越慢。
3. 自覺經濟狀況越差者,初始Nagi失能程度越高;而自覺經濟狀況越好的人,Nagi失能速度越慢。


二、 社經地位因素與IADL失能改變情形之關係
1. 教育程度越低,初始IADL失能程度越高;IADL失能速度越快。
2. 職業類別與初始Nagi失能程度及速度沒有相關。
3. 自覺經濟狀況越差者,初始IADL失能程度越高;而自覺經濟狀況越好的人,IADL失能程度速度越慢。
三、 社經地位因素與ADL失能改變情形之關係
1. 教育程度與初始ADL失能程度及速度沒有相關。
2. 職業類別與初始ADL失能程度及速度沒有相關。
3. 自覺經濟狀況越差者,初始IADL失能程度越高;但與ADL失能速度無關。

四、 相關影響因素對於社經地位及失能改變之關係
健康狀態能解釋社經地位與失能改變關係中最多的變異數比例;其次為社會心理因素及健康行為。

社會福利及衛生相關單位應加強注意危險族群之健康轉變及照護需求。針對年老者,應著重於提供適切的、可近性高的醫療及長期照護服務,並改善居住環境或社區環境以提供更多的社會支持,降低老年人之失能風險、延緩其失能程度之惡化。針對年輕者,應著力於健康促進、健康社區營造,加強中老年人參與社會活動,以提升中老年人的社會參與活躍性,維持心靈、社會及身體上的健康,延後失能的發生,以達到成功老化之目標。
Background: The impact of socio-economic factors on health is well documented. Lots of studies found that there is an inverse direction or relationship among SES and disability. However, most studies focus on the risk of disability among the difference of SES, seldom focus on the changes of disability. Even they do, usually for two points in time measurement, and couldn’t reflect the true trajectory of disability change. In addition, disability in elderly is related to many diseases and others non-disease factors, some factors have also been shown to be a predictor of mortality. Therefore, it’s necessary to explore the disability change among the difference of socio-economic factors, and to know what factor to intervene upon in order to reduce the disability change and socio-economic difference.The purpose of this study are: (1)To examine the impact of socio-economic factors on disability change over 10 years among a representative sample of Taiwan elderly.(2) To determine the relative contribution of health, behavioral nd psychosocial factors in explain this relation.

Methods: Data were from 2,759 men and women, aged 65 years old at least, participating in The Longitudinal Survey of Health and Living Status of the Elderly in Taiwan 1993-2003 (panel study). 3 indicator of socio-economic status were used: education, social class, self-perceived economic status. Disability was measure by Nagi, IADL and ADL. Multilevel analysis with mixed model (linear growth model) in SAS 9.2, were used to examine the association between Socio-economic factors and longitudinal change in disability.

Results: The study found that education is strongly associated with Nagi and IADL but not with ADL, elderly with lower education level not only had a significant higher IADL disability level at baseline but also increase significant more over 10 years compared to the higher education level. The study also found that the Nagi disability level had a significant increase among the lower social class but not significant difference in ADL and IADL. And the self-perceived economic status is associated with Nagi, IADL and ADL, the lower self-perceived economic status not only had a significant disability level at baseline, but also increase significant more over 10 years. On the other hands, health conditions such as diseases and self-rated health were the most important factors which can contribute the most explanation of SES difference in disability.

Conclusion: The findings of this study are consisted with previous studies, which indicated that lower SES have greater risk of disability compare to the higher SES, and this study has further indicated the SES difference on change of disability. According to the outcomes, this study recommends that the government should integrate the SES difference and health inequality concept into the National Pension and Long-term care policy.
致謝 I
摘要 II
目錄 V
表目錄 VII
圖目錄 IX
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的及問題 3
第三節 研究重要性 3
第四節 重要名詞解釋 3
第二章 文獻探討 4
第一節 失能之定義及測量方法 4
第二節 社經地位之定義與測量及實證研究 9
第三節 社經地位與失能實證研究 14
第四節 階層線性模式與縱貫研究 21
第三章 材料與方法 29
第一節 研究設計與架構 29
第二節 研究假說 31
第三節 資料來源與研究對象 32
第四節 研究變項與測量 34
第五節 資料處理與統計分析 40
第四章 研究結果 41
第一節 老年人特質分佈 41
第二節 社經地位與失能之相關 43
第三節 失能程度與各因素之相關 45
第四節 線性成長模型之分析 47
第五章 討論 86
第一節 分析結果之討論 86
第二節 研究方法之討論 96
第三節 研究限制 97
第六章 結論與建議 98
第一節 結論 98
第二節 建議 100
參考文獻 101

表目錄
表2-3-1 社經地位與失能實證研究整理………….……………......................19
表3-3-1 原始調查各年度完訪率……………………………………………...32
表3-1-2 1993-2003年65歲以上老人樣本追蹤情形…………….……………33
表3-3-3 排除代答者前後樣本分佈情形……………………………………...33
表3-4-1個體層次變項………………………………………………………....38
表3-4-2個體內層次變項……………………………………………………....39
表3-5-1統計分析表…………………………………………………………....40
表4-1-1基本特質分佈........................................................................................68
表4-2-1教育程度與失能程度及相關影響因素之雙變項分析-1993………...70
表4-2-2社會階層與失能程度雙變項分析........................................................71
表4-2-3自覺經濟狀況與失能程度之雙變項分析………….………………...72
表4-3-1 NAGI失能程度與各因素之雙變項分析…………………………….73
表4-3-2IADL障礙程度與各因素之雙變項分析…………………………......74
表4-3-3 ADL障礙程度與各因素之雙變項分析…………………………...…75
表4-4-1 1993-2003年失能程度之成長模型-完全無條件模型………………76
表4-4-2 1993-2003年失能程度無條件線性成長模型……………………….76
表4-4-3 1993-2003年Nagi失能程度條件線性成長模型-教育程度………..77
表4-4-4 1993-2003年Nagi失能程度條件線性成長模型-社會階層………..78
表4-4-5 1993-2003年Nagi失能程度條件線性成長模型-自覺經濟狀況…..79
表4-4-6 1993-2003年IADL失能程度條件線性成長模型-教育程度……….80
表4-4-7 1993-2003年IADL失能程度條件線性成長模型-社會階層……….81
表4-4-8 1993-2003年IADL失能程度條件線性成長模型-自覺經濟狀況…82
表4-4-9 1993-2003年ADL失能程度條件線性成長模型-教育程度……..…83
表4-4-10 1993-2003年ADL失能程度條件線性成長模型-社會階層………84
表4-4-11 1993-2003年ADL失能程度條件線性成長模型-自覺經濟狀態….85
表5-1-1 社經地位因素與Nagi失能程度及改變之關係整理表…………….92
表5-1-2 社經地位因素與IADL失能程度及改變之關係整理表…………...93
表5-1-3 社經地位因素與ADL失能程度及改變之關係整理表……………94
表5-1-4失能之初始值及失能速度由社經地位及共變數所解釋之變異數比例整理表..……………………………………………………………………………95

圖目錄
圖2-1-1 the disablement process…………………………………………………5
圖2-3-1總體與個體層次的研究方法設計……………………………………22
圖3-1-1 研究架構圖…...………...…………………………………….………30
參考文獻
Adamson, J., K. Hunt, et al. (2003). Socioeconomic position, occupational exposures, and gender: the relation with locomotor disability in early old age, BMJ. 57: 453-455.

Adler, N. E. and K. Newman (2002). "Socioeconomic Disparities In Health: Pathways And Policies." < I> Health Affairs 21(2): 60.

Andresen, E. and D. Miller (2005). "The Future (History) of Socioeconomic Measurement and Implications for Improving Health Outcomes Among African Americans." Journals of Gerontology Series A: Biological and Medical Sciences 60(10): 1345-1350.

Berkman, L. and I. Kawachi (2000). "Social epidemiology." Health Education Research.

Beydoun, M. and B. Popkin (2005). "The impact of socio-economic factors on functional status decline among community-dwelling older adults in China." Social Science & Medicine 60(9): 2045-2057.

Boult, C., R. L. Kane, et al. (1994). "Chronic conditions that lead to functional limitation in the elderly." The Journals of gerontology 49(1): 28-36.

Brunner, E. J., M. G. Marmot, et al. (1997). "Social inequality in coronary risk: central obesity and the metabolic syndrome. Evidence from the Whitehall II study." Diabetologia 40(11): 1341-1349.

CHIU, H., Y. HSIEH, et al. (2005). "Associations between socio-economic status measures and functional change among older people in Taiwan." Ageing and Society 25(03): 377-395.

Chiu, H. C., L. W. Mau, et al. (2004). "Chronic medical conditions as predictors of functional disability in an older population in Taiwan." Australasian Journal on Ageing 23(1): 19-24.



Coppin, A., L. Ferrucci, et al. (2006). "Low Socioeconomic Status and Disability in Old Age: Evidence From the InChianti Study for the Mediating Role of Physiological Impairments." Journals of Gerontology Series A: Biological and Medical Sciences 61(1): 86-91.

Everson, S., S. Maty, et al. (2002). "Epidemiologic evidence for the relation between socioeconomic status and depression, obesity, and diabetes." J Psychosom Res 53(4).

Feinstein, J. S. (1993). "The relationship between socioeconomic status and health: a review of the literature." Milbank Q 71(2): 279-322.

Femia, E., S. Zarit, et al. (2001). "The Disablement Process in Very Late Life A Study of the Oldest-Old in Sweden." Journals of Gerontology Series B: Psychological Sciences and Social Sciences 56(1): 12-23.

Gruenewald, T., A. Karlamangla, et al. (2007). "Feelings of usefulness to others, disability, and mortality in older adults: The MacArthur Study of Successful Aging." Journals of Gerontology Series B: Psychological Sciences and Social Sciences 62(1): P28.

Grundy, E. (2000). "Socio-demographic differences in the onset and progression of disability in early old age: a longitudinal study." Age and Ageing 29(2): 149-157.

Jagger, C., R. Matthews, et al. (2007). "Educational differences in the dynamics of disability incidence, recovery and mortality: Findings from the MRC Cognitive Function and Ageing Study (MRC CFAS)." International Journal of Epidemiology 36(2): 358.

Johannes Siegrist and M. Marmot (2006). Social Inequalities in Health: New Evidence and Policy Implication, Oxford University Press Inc., New York.

Kempen, G., M. J. G. van Heuvelen, et al. (1999). "The relationship of functional limitations to disability and the moderating effects of psychological attributes in community-dwelling older persons." Social Science & Medicine 48(9): 1161-1172.

Koster, A., H. Bosma, et al. (2006). "Explanations of socioeconomic differences in changes in physical function in older adults: results from the Longitudinal Aging Study Amsterdam." BMC Public Health 6(1): 244.

Koster, A., H. Bosma, et al. (2005). "The role of psychosocial factors in explaining socio-economic differences in mobility decline in a chronically ill population: results from the GLOBE study." Social Science & Medicine 61(1): 123-132.

Koster, A., B. Penninx, et al. (2005). "Is There a Biomedical Explanation for Socioeconomic Differences in Incident Mobility Limitation?" Journals of Gerontology Series A: Biological and Medical Sciences 60(8): 1022-1027.

Lee, Y. and S. Shinkai (2003). "A comparison of correlates of self-rated health and functional disability of older persons in the Far East: Japan and Korea." Archives of Gerontology and Geriatrics 37(1): 63-76.

Li, C. Y., S. C. Wu, et al. (2000). "Longest held occupation in a lifetime and risk of disability in activities of daily living." Occupational and Environmental Medicine 57(8): 550-554.

Li, L. (2005). "Predictors of ADL disability trajectories among low-income frail elders in the community." Research on Aging 27(6): 615.

Li, L. and Y. Conwell (2009). "Effects of Changes in Depressive Symptoms and Cognitive Functioning on Physical Disability in Home Care Elders." The Journals of Gerontology: Series A.

Matthews, R. J., L. K. Smith, et al. (2005). "Socioeconomic factors associated with the onset of disability in older age: a longitudinal study of people aged 75 years and over." Social Science & Medicine 61(7): 1567-1575.

McColl, M. and S. Shortt (2006). "Another way to look at high service utilization: the contribution of disability." Journal of Health Services Research & Policy 11(2): 74.

Pickett, K. E. and M. Pearl (2001). Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review, BMJ. 55: 111-122.

Popa, M., S. Reynolds, et al. (2009). "Is the Effect of Reported Physical Activity on Disability Mediated by Cognitive Performance in White and African American Older Adults?" The Journals of Gerontology: Series B 64(1): 4.

Puts, M. T. E., P. Lips, et al. (2005). "Sex Differences in the Risk of Frailty for Mortality Independent of Disability and Chronic Diseases." Journal of the American Geriatrics Society 53(1): 40-47.

Ramsay, S., P. Whincup, et al. (2008). "Extent of social inequalities in disability in the elderly: results from a population-based study of British men." Annals of Epidemiology 18(12): 896-903.

Rautio, N., J. Adamson, et al. (2006). "Associations of socio-economic position and disability among older women in Britain and Jyv酲kyl? Finland." Archives of Gerontology and Geriatrics 42(2): 141-155.

Reynolds, S. and M. Silverstein (2003). "Observing the onset of disability in older adults." Social Science & Medicine 57(10): 1875-1889.

Satariano, W. (2005). Epidemiology of aging: An ecological approach, Jones & Bartlett Publishers.

Seeman, T. E., P. A. Charpentier, et al. (1994). "Predicting changes in physical performance in a high-functioning elderly cohort: MacArthur studies of successful aging." J Gerontol 49(3): M97-108.

Shavers, V. L. (2007). "Measurement of Socioeconomic Status in Health Disparities Research." JOURNAL-NATIONAL MEDICAL ASSOCIATION 99(9): 1013.

Stafford, M., H. Hemingway, et al. (1998). "Behavioural and biological correlates of physical functioning in middle aged office workers: the UK whitehall II study." Journal of Epidemiology & Community Health 52(6): 353-358.

Stephen W. Raudenbush and A. S. Bryk (2008). Hierarchical Linear Models: Applications and Data Analysis Methods(second edition), 五南.


Strawbridge, W. J., R. D. Cohen, et al. (1996). Successful Aging: Predictors and Associated Activities, Oxford Univ Press. 144: 135-141.

Twisk, J. W. R. (2003). Applied Longgitudinal Data Analysis for Epidemiology: A Practical Guide, The Press Syndicate of the University of Campbridge.

WHO "http://www.who.int/topics/disabilities/en/."

Woo, J., S. C. Ho, et al. (2000). "The influence of income on morbidity, mortality and dependency in elderly Hong Kong Chinese." Archives of Gerontology and Geriatrics 30(1): 55-61.

Zimmer, Z., X. Liu, et al. (1998). "Educational attainment and transitions in functional status among older Taiwanese." Demography: 361-375.
























中華民國統計網. from http://www.stat.gov.tw/ct.asp?xItem=15810&ctNode=1310.

何景隆 (2007). 多層次資料之成長模式分析:以大學生情緒調節與負向情感之動態變化為例, 輔仁大學心理學研究所. 碩士: 102

吳淑瓊, 徐慧娟, et al. (1996). "功能評估在估計台灣社區老人長期照護需要之應用." 中華公共衛生雜誌 15(6): 533-545.

李禹陞 (2006). 台灣地區鄰里型態與個人社會經濟地位對個人健康之影響. 公共衛生學研究所, 台北醫學大學. 碩士: 97.

李靜芳 and 溫福星 (2008). "階層線性模式於追蹤研究之應用-以子宮切除婦女之術後初期症狀困擾為例." 護理雜誌 55(4): 63-72.

胡幼慧 (1991). 社會流行病學, 台北市:巨流.

徐慧娟 and 張明正 (2004). 臺灣老人成功老化與活躍老化現況: 多層次分析, 台灣社會福利學刊.

梁玲郁, 張傢鈺, et al. (2008). 台灣地區無失能平均餘命趨勢------疾病擴張或壓縮. 臺灣人口學會2008年學術研討會.

郭怡汾 (2001). 社經地位, 地區剝奪與老人存活狀況. 衛生政策與管理研究所, 台灣大學. 碩士: 93.

董和銳 (2004). "族群與臺灣老年人之日常生活障礙與功能限制." 身心障礙研究 2(3): 160-175.

董和銳 (2005). "台灣老年人口自評健康與功能障礙情形之轉變." 身心障礙研究 3(2): 72-87.

温福星 (2006). 階層線性模式:原理、方法與應用, 雙葉.
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top