臺灣博碩士論文加值系統

研究目的：全球失智症人口快速增加，國際失智症協會（ADI）資料顯示全球平均每3秒就有一人罹患失智症。相同的，台灣人口高齡化，失智症者比例也持續增加，另失智症主要症狀是記憶力衰退和認知功能障礙，如何延緩認知功能衰退成重要課題。然而在政策推動下，居住在社區的中老年人社會支持網絡建構跟認知功能關係逐漸受到重視。過去文獻中社會支持網絡對認知功能之間影響有關，但在台灣相關研究大部分以橫斷性研究為主，探討社會支持網絡面向涵蓋範圍較小，且研究年齡層也著重於65歲以上老人。因此，本研究目的為探討國內社區50歲以上中老年人社會支持網絡系統與認知功能變化兩者之間關係。

研究方法：本研究使用「中老年身心社會生活狀況長期追蹤調查」進行分析，以2003年、2007年及2011年第五波、第六波與第七波調查資料為主。研究對象為4898位社區的中老年人，研究樣本以2003年50歲以上的中老年人及2007年與2011年同一世代的追蹤樣本進行研究。依變項為簡易心智狀態問卷調查表(Short Portable Mental Status Questionnaire,SPMSQ)。自變項為居住型態、情緒性支持、工具性支持及兄弟結妹、親友及鄰居的每週聯絡人數。以混合線性模型(linear mixed effects model) 統計分析社會支持網絡與認知功能改變之間的關係。

研究結果：在居住型態的部分，與配偶居住以及研究對象與配偶及子女居住者比起與子女或其他親友居住或獨居者，認知功能下降較為緩慢。情緒性支持分數較高者，其認知功能分數下降較慢；工具性支持分數越高與認知功能分數下降越快有關。在聯絡對象為兄弟姊妹和鄰居或朋友部分，每週聯絡1位以上兄弟姊妹與認知功能下降較慢有關；每週聯絡鄰居或朋友人數超過7位者，認知功能分數顯著下降緩慢。
結論：居住形態中，與子女或其他親友居住以及獨居者這兩種類型，其認知功能分數下降較快。研究顯示，情緒性支持分數愈高，則認知功能分數下降愈慢；而工具性支持結果恰好相反。另外，與兄弟姊妹及朋友鄰居聯絡人數愈多，其認知功能分數下降愈慢。因此，未來方向應如何幫助在社區的中老年人走進社區，維持良好的社會網絡及社會支持，打造有利中老年人的社會環境，以達預防或延緩中老年人的認知功能退化情形。

OBJECTIVES：As populations around the world with dementia increase rapidly, Alzheimer's Disease International(ADI) data shows that an average of one person suffers from dementia every 3 seconds.Similarly,the population of Taiwan are aging,patients with dementia increase continuously,additional memory decline and cognitive impairment are main symptoms of dementia, how to delay cognitive decline becomes an important issue. However, with the policy of promoting,among community‐dwelling middle aged and elderly adults the relationship between construction of social support networks and cognitive function is getting increasing attention Previous studies shows that the association between social support networks and cognitive function,but in Taiwan the relevant research mainly focued on the cross-sectional study,discussion of covers narrow on the aspect of social support networks,and study age groups also focued on the elderly aged 65 and over. Therefore, the purpose of this research was to explore the association between social support networks and changes in cognitive functions among community‐dwelling middle aged and elderly adults.

METHODS：The research utilizes analysis from Taiwan Longitudinal Study in Aging (TLSA) was conducted,with the fifth, sixth and seventh waves in 2003, 2007 and 2011 as survey data. The study objects comprised of 4,898 community‐dwelling middle aged and elderly adults,and study samples were middle aged and elderly adults over the age of 50 in 2003, and same cohort samples in 2007 and 2011 .Dependent variable was Short Portable Mental State Questionnaire(SPMSQ), independent variables were living arrangements, emotional support, instrumental support and person who had kept in touch weekly with siblings, relatives and neighbors or friends. The association between social support networks and changes in cognitive functions were applied in statistics analysis by linear mixed effects model.

RESULTS：For Living Arrangements, living with spouse and the study sample who lived with spouse and children had slower rate of decline in cognitive function compared with living with children or other relatives or living alone.Higher emotional support scores were associated with slower decline in cognitive function;higher instrumental support scores were associated with greater decline in cognitive function.For keeping in touch with siblings and neighbors or friends, person with more 1 who had kept in touch weekly with siblings were associated with slower decline in cognitive function; person with more 7 who had kept in touch weekly with neighbors or friends were associated with significantly slower decline in cognitive function.

CONCLUSIONS：For Living Arrangements,the two types of living with children or other relatives or living alone, their cognitive function scores fell rapidly. The result showed that higher emotional support scores were associated with slower decline in cognitive function;and the reverse of the result arrived at by instrumental support. In addition,the more people who contacts with siblings and neighbors or friends were associated with slower decline in cognitive function. Therefore, future study may be how to help entrance into community among community‐dwelling middle aged and elderly adults, maintain good social networks and social support, create the favorable social environment for middle aged and elderly adults,and arrive at prevention or defer in cognitive function that middle aged and elderly adults decline.

目　錄
致謝 I
摘要 II
Abstract IV
目錄 VI
表目錄 VIII
圖目錄 VIII
附表目錄 VIII
第一章 前言 1
第一節 研究背景及動機 1
第二節 研究目的及研究假說 3
第二章 文獻回顧 4
第一節 社會支持網絡論述 4
第二節 中老年人的各別社會支持網絡跟認知功能關係 5
第三章 研究方法 7
第一節 研究架構 7
第二節 研究資料 7
第三節 研究對象 8
第四節 研究工具 9
第五節 資料處理與統計分析 12
第四章 研究結果 14
第一節 研究對象基本資料描述 14
第二節 個別社會支持網絡與認知功能改變之相關性 15
第五章 研究討論 20
第一節 主要研究結果 20
第二節 研究結果討論 20
第三節 研究優勢及限制 26
第六章 結論與建議 28
第一節 結論 28
第二節 建議 29
參考文獻 30
附錄A 54

表目錄
表3.2研究年份(2003年、2007年、2011年)應訪案數、完訪案數、死亡案數及無法完成數之一覽表 8
表3.4.1 認知功能評估項目(擷取附錄A) 9
表3.4.2 情緒性支持評估項目(擷取附錄A) 10
表4.1 研究對象描述性資料 37
表4.2.1居住型態與認知功能改變之相關性 39
表4.2.2情緒性支持與認知功能改變之相關性 40
表4.2.3情緒性支持與認知功能改變之相關性 41
表4.2.4工具性支持與認知功能改變之相關性 42
表4.2.5工具性支持與認知功能改變之相關性 43
表4.2.6每週與兄弟姊妹聯絡人數與認知功能改變之相關性 44
表4.2.7每週與其他親戚聯絡人數與認知功能改變之相關性 45
表4.2.8每週與朋友鄰居聯絡人數與認知功能改變之相關性 46

圖目錄
圖4.2.1 居住型態與認知功能變化 47
圖4.2.2 情緒性支持與認知功能變化 47
圖4.2.3 工具性支持與認知功能變化 48
圖4.2.4 每週和兄弟姊妹聯絡人數與認知功能變化 48
圖4.2.5 每週和其他親戚聯絡人數與認知功能變化 49
圖4.2.6 每週和朋友鄰居聯絡人數與認知功能變化 49

附表目錄
附表1 社會支持網絡因子與認知功能分數之相關性 50
附表2 居住型態與認知功能分數遺漏值之分布 51
附表3 工具性支持分數與ADL、IADL之分析 52
附表4 2003、2007、2011遺漏值分布 53

參考文獻
英文部分
Alzheimer’sDiseaseInternational, 2018. World Alzheimer Report 2018 The state of the art of dementia research:New frontiers.
Bassuk, S.S., Glass, T.A., Berkman, L.F., 1999. Social disengagement and incident cognitive decline in community-dwelling elderly persons. Annals of internal medicine 131, 165-173.
Bonsang, E., Bordone, V., 2013. The effect of informal care from children on cognitive functioning of older parents.
Bordone, V., Weber, D., 2012. Number of children and cognitive abilities in later life. Vienna Yearbook of Population Research 10, 95-126.
Brass, D.J., 2011. A social network perspective on industrial/organizational psychology. Handbook of industrial and organizational psychology 1, 107-117.
Cacioppo, J.T., Cacioppo, S., 2014. Social relationships and health: The toxic effects of perceived social isolation. Social and personality psychology compass 8, 58-72.
Cahn-Weiner, D.A., Farias, S.T., Julian, L., Harvey, D.J., Kramer, J.H., Reed, B.R., Mungas, D., Wetzel, M., Chui, H., 2007. Cognitive and neuroimaging predictors of instrumental activities of daily living. Journal of the International Neuropsychological Society 13, 747-757.
Carstensen, L.L., 2006. The influence of a sense of time on human development. Science 312, 1913-1915.
Chan, A., 2005. Aging in Southeast and East Asia: issues and policy directions. Journal of Cross-Cultural Gerontology 20, 269-284.
Chen, T.-Y., Chang, H.-Y., 2016. Developmental patterns of cognitive function and associated factors among the elderly in Taiwan. Scientific reports 6, 33486.
Cobb, S., 1976. Social support as a moderator of life stress. Psychosomatic medicine.
Crooks, V.C., Lubben, J., Petitti, D.B., Little, D., Chiu, V., 2008. Social network, cognitive function, and dementia incidence among elderly women. Am J Public Health 98, 1221-1227.
Dickinson, W.J., Potter, G.G., Hybels, C.F., McQuoid, D.R., Steffens, D.C., 2011. Change in stress and social support as predictors of cognitive decline in older adults with and without depression. International journal of geriatric psychiatry 26, 1267-1274.
Ellwardt, L., Aartsen, M., Deeg, D., Steverink, N., 2013. Does loneliness mediate the relation between social support and cognitive functioning in later life? Social science & medicine 98, 116-124.
Fratiglioni, L., Wang, H.-X., Ericsson, K., Maytan, M., Winblad, B., 2000. Influence of social network on occurrence of dementia: a community-based longitudinal study. The lancet 355, 1315-1319.
Glei, D.A., Landau, D.A., Goldman, N., Chuang, Y.-L., Rodriguez, G., Weinstein, M., 2005a. Participating in social activities helps preserve cognitive function: an analysis of a longitudinal, population-based study of the elderly. International journal of epidemiology 34, 864-871.
Glei, D.A., Landau, D.A., Goldman, N., Chuang, Y.L., Rodriguez, G., Weinstein, M., 2005b. Participating in social activities helps preserve cognitive function: an analysis of a longitudinal, population-based study of the elderly. Int J Epidemiol 34, 864-871.
Gow, A.J., Corley, J., Starr, J.M., Deary, I.J., 2013. Which social network or support factors are associated with cognitive abilities in old age? Gerontology 59, 454-463.
Green, A.F., Rebok, G., Lyketsos, C.G., 2008. Influence of social network characteristics on cognition and functional status with aging. International Journal of Geriatric Psychiatry: A journal of the psychiatry of late life and allied sciences 23, 972-978.
Harada, C.N., Love, M.C.N., Triebel, K.L., 2013. Normal cognitive aging. Clinics in geriatric medicine 29, 737-752.
Helmer, C., Damon, D., Letenneur, L., Fabrigoule, C., Barberger-Gateau, P., Lafont, S., Fuhrer, R., Antonucci, T., Commenges, D., Orgogozo, J., 1999. Marital status and risk of Alzheimer’s disease: a French population-based cohort study. Neurology 53, 1953-1953.
Håkansson, K., Rovio, S., Helkala, E.-L., Vilska, A.-R., Winblad, B., Soininen, H., Nissinen, A., Mohammed, A.H., Kivipelto, M., 2009. Association between mid-life marital status and cognitive function in later life: population based cohort study. Bmj 339, b2462.
Holt-Lunstad, J., Smith, T.B., Layton, J.B., 2010. Social relationships and mortality risk: a meta-analytic review. PLoS medicine 7, e1000316.
House, J.S., Umberson, D., Landis, K.R., 1988. Structures and processes of social support. Annual review of sociology 14, 293-318.
Hughes, M.E., Waite, L.J., 2002. Health in household context: Living arrangements and health in late middle age. Journal of health and social behavior 43, 1.
Hupcey, J.E., 1998. Clarifying the social support theory‐research linkage. Journal of advanced nursing 27, 1231-1241.
Kotwal, A.A., Kim, J., Waite, L., Dale, W., 2016. Social function and cognitive status: Results from a US nationally representative survey of older adults. Journal of general internal medicine 31, 854-862.
Krueger, K.R., Wilson, R.S., Kamenetsky, J.M., Barnes, L.L., Bienias, J.L., Bennett, D.A., 2009. Social engagement and cognitive function in old age. Exp Aging Res 35, 45-60.
Kuiper, J.S., Zuidersma, M., Voshaar, R.C.O., Zuidema, S.U., van den Heuvel, E.R., Stolk, R.P., Smidt, N., 2015. Social relationships and risk of dementia: A systematic review and meta-analysis of longitudinal cohort studies. Ageing research reviews 22, 39-57.
Langford, C.P.H., Bowsher, J., Maloney, J.P., Lillis, P.P., 1997. Social support: a conceptual analysis. Journal of advanced nursing 25, 95-100.
Lee, W.J., Liang, C.K., Peng, L.N., Chiou, S.T., Chen, L.K., 2017. Protective factors against cognitive decline among community‐dwelling middle‐aged and older people in Taiwan: A 6‐year national population‐based study. Geriatrics & gerontology international 17, 20-27.
Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S., Huntley, J., Ames, D., Ballard, C., Banerjee, S., Burns, A., Cohen-Mansfield, J., 2017a. The Lancet International Commission on Dementia Prevention and Care. Lancet 390, 2673-2734.
Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S.G., Huntley, J., Ames, D., Ballard, C., Banerjee, S., Burns, A., Cohen-Mansfield, J., Cooper, C., Fox, N., Gitlin, L.N., Howard, R., Kales, H.C., Larson, E.B., Ritchie, K., Rockwood, K., Sampson, E.L., Samus, Q., Schneider, L.S., Selbæk, G., Teri, L., Mukadam, N., 2017b. Dementia prevention, intervention, and care. The Lancet 390, 2673-2734.
Mazzuco, S., Meggiolaro, S., Ongaro, F., Toffolutti, V., 2013. Living arrangements and cognitive decline among the elderly in Europe. HEG Working Paper.
Moritz, D.J., Kasl, S.V., Berkman, L.F., 1995. Cognitive functioning and the incidence of limitations in activities of daily living in an elderly community sample. American Journal of Epidemiology 141, 41-49.
MOUSAVI‐NASAB, S.M.H., Kormi‐Nouri, R., Sundström, A., Nilsson, L.G., 2012. The effects of marital status on episodic and semantic memory in healthy middle‐aged and old individuals. Scandinavian journal of psychology 53, 1-8.
Pfeiffer, E., 1975. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of the American Geriatrics Society 23, 433-441.
Sörman, D.E., Rönnlund, M., Sundström, A., Norberg, M., Nilsson, L.-G., 2017. Social network size and cognitive functioning in middle-aged adults: Cross-sectional and longitudinal associations. Journal of adult development 24, 77-88.
Seeman, T.E., Lusignolo, T.M., Albert, M., Berkman, L., 2001. Social relationships, social support, and patterns of cognitive aging in healthy, high-functioning older adults: MacArthur studies of successful aging. Health psychology 20, 243.
Seeman, T.E., Miller-Martinez, D.M., Stein Merkin, S., Lachman, M.E., Tun, P.A., Karlamangla, A.S., 2011. Histories of social engagement and adult cognition: Midlife in the US study. Journals of Gerontology Series B: Psychological Sciences and Social Sciences 66, i141-i152.
Sun, Y., Lee, H.-J., Yang, S.-C., Chen, T.-F., Lin, K.-N., Lin, C.-C., Wang, P.-N., Tang, L.-Y., Chiu, M.-J., 2014. A nationwide survey of mild cognitive impairment and dementia, including very mild dementia, in Taiwan. PloS one 9, e100303.
Thoits, P.A., 1982. Conceptual, methodological, and theoretical problems in studying social support as a buffer against life stress. Journal of Health and Social behavior, 145-159.
Uchino, B.N., 2009. Understanding the links between social support and physical health: A life-span perspective with emphasis on the separability of perceived and received support. Perspectives on psychological science 4, 236-255.
van Gelder, B.M., Tijhuis, M., Kalmijn, S., Giampaoli, S., Nissinen, A., Kromhout, D., 2006. Marital status and living situation during a 5-year period are associated with a subsequent 10-year cognitive decline in older men: the FINE Study. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 61, P213-P219.
Van Tilburg, T.G., 1995. Delineation of the social network and differences in network size. Living arrangements and social networks of older adults, 83-96.
Whalley, L.J., Deary, I.J., Appleton, C.L., Starr, J.M., 2004. Cognitive reserve and the neurobiology of cognitive aging. Ageing research reviews 3, 369-382.
Wu, M.-S., Lan, T.-H., Chen, C.-M., Chiu, H.-C., Lan, T.-Y., 2011. Socio-demographic and health-related factors associated with cognitive impairment in the elderly in Taiwan. BMC public health 11, 22.
Yeh, S.-C.J., Liu, Y.-Y., 2003. Influence of social support on cognitive function in the elderly. BMC Health services research 3, 9.
Yen, Y.C., Yang, M.J., Shih, C.H., Lung, F.W., 2004. Cognitive impairment and associated risk factors among aged community members. International Journal of Geriatric Psychiatry 19, 564-569.
Zamora-Macorra, M., de Castro, E.F.A., Ávila-Funes, J.A., Manrique-Espinoza, B.S., López-Ridaura, R., Sosa-Ortiz, A.L., Shields, P.L., del Campo, D.S.M., 2017. The association between social support and cognitive function in Mexican adults aged 50 and older. Archives of gerontology and geriatrics 68, 113-118. 
中文部分
內政部戶政司, 2018. 人口統計資料.
台灣失智症協會, 2019. 台灣失智症協會.
周玉慧, 楊文山, 莊義利, 1998. 晚年生活壓力, 社會支持與老人身心健康. 人文及社會科學集刊 10, 227-265.
張家銘, 蔡智能, 2003. 老年人之周全性評估. 台灣醫學 7, 364-374