進階搜尋


 
系統識別號 U0026-0812200915213033
論文名稱(中文) 台灣老人居住安排與死亡率
論文名稱(英文) Living arrangements and mortality among elderly in Taiwan
校院名稱 成功大學
系所名稱(中) 公共衛生研究所
系所名稱(英) Graduate Institute of Public Health
學年度 97
學期 2
出版年 98
研究生(中文) 黃于珊
研究生(英文) Yu-shan Huang
電子信箱 t8696102@mail.ncku.edu.tw
學號 t8696102
學位類別 碩士
語文別 中文
論文頁數 84頁
口試委員 指導教授-呂宗學
指導教授-楊靜利
口試委員-喬芷
中文關鍵字 老人  死亡率  居住安排 
英文關鍵字 elderly  mortality  living arrangements 
學科別分類
中文摘要 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。
英文摘要 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.
論文目次 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
參考文獻 1. 行政院主計處 (1994). 中華民國八十三年七月至九月台灣地區調查統計資訊季報第二十二期.
2. 內政部 (2005). 老人狀況調查報告.
3. 內政部 (2002). 老人狀況調查報告.
4. 內政部 (2000). 老人狀況調查報告.
5. 內政部 (1996). 老人狀況調查報告.
6. 陳妙盡, 王德睦, & 莊義利 (1987). 台灣地區老人健康狀況與居住安排. 人口老化與老年照護, 325-357.
7. 齊力 (1990). 台灣地區近二十年來家戶核心化趨勢的研究. 國立台灣大學社會學刊, 20, 41-83.
8. 齊力 (1995). 臺灣地區老人居住安排與社會支持研究. 行政院國家科學委員會補助專題研究報告.
9. 伊慶春, & 陳玉華 (1998). 奉養父母方式與未來奉養態度之關聯. 人口學刊, 19,1-32.
10. 羅紀瓊 (1987). 近十年來台灣地區老人家庭結構變遷之研究. 臺灣經濟預測, 18(2), 83-107.
11. 呂寶靜 (2001). 老人照顧:老人、家庭、正式服務. 台北: 五南.
12. 楊靜利 (1999). 老年人的居住安排—子女數量與同居傾向因素之探討. 人口學刊, 20, 167-183.
13. 楊靜利, &董宜禎(2007) .台灣的家戶組成變遷:1990-2050.台灣社會學刊38, 135-173.
14. 王香蘋(2003).台灣老人罹病,活動功能,及健康自評的分析:1989年-1996年.台灣社會福利學刊,2(1),77-106
15. 陳肇男 (1999). 老年三寶:老本、老伴與老友.台北:中研院經濟所.
16. 陳正芬 (2006). 從老人居住安排及未滿足需求論我國長期照護政策. 國立中正大學社會福利所博士論文.
17. 陳明珍 (2001). 我國推展老人居家服務政策之探討. 長期照護, 5(1), 13-25.
18. 胡幼慧 (1995). 三代同堂—迷思與陷阱. 台北: 巨流.
19. 謝繼昌 (1986). 輪伙頭制度初探. 中央研究院民族學研究所集刊, 59, 91-100.
20. Berkman, L. F., & Kawachi, I. (2000). Social Epidemiology . (p.137-173). New York: Oxford University Press.
21. Blieszner, R., & Bedford, V. H. (2007). 林歐貴英等譯.老年與家庭 :理論與研究 臺北市: 五南圖書.
22. Blazer, D. (1982). Social support and mortality in an elderly community population. American Journal of Epidemiology, 115(5), 684-694.
23. Brown, J. W., Liang, J., Krause, N., Akiyama, H., Sugisawa, H., & Fukaya, T. (2002). Transitions in living arrangements among elders in Japan : does health make a difference? The Journals of Gerontology. Series B, Psychological sciences and social sciences, 57(4), 209-220.
24. Burg, M., & Seeman, T. (1994). Families and health:the negative side of social ties. Annals of Behavioral Medicine, 16, 109-109.
25. Cafferata, G. (1987). Marital status, living arrangements, and the use of health services by elderly persons. Journal of Gerontology, 42(6), 613-618.
26. Campion, E. (1996). Home alone, and in danger. New England Journal of Medicine, 334(26), 1738-1739.
27. Chappell, N. L. (1991). Living arrangements and sources of caregiving. Journal of Gerontology , 46(1), S1-S8.
28. DaVanzo, J., & Chan, A. (1994). Living arrangements of older Malaysians: who coresides with their adult children. Demography, 31(1), 95-113.
29. Davis, M. A., John M, N., Mortiz, D. J., & Segal, M. R. (1992). Living arrangements and survival among middle-aged and older adults in the NHANES I epidemiologic follow-up study. American Journal of Public Health, 82(3),401-406.
30. Davis, M. A., Moritz, D. J., Neuhaus, J. M., Barclay, J. D., & Gee, L. (1997). Living arrangements, changes in living arrangements, and survival among community Dwelling older adults. American Journal of Public Health, 87(3), 371-377.
31. Ferraro, K.F., & Farmer, M. M. (1999). Utility of health data from social surveys: is there a gold standard for measuring morbidity? American Sociological Review, 64(2), 303–315.
32. Frankenberg, E., Chan, A., & Ofstedal, M. B. (2002). Stability and change in living arrangements in Indonesia, Singapore, and Taiwan, 1993-99. Population Studies, 56(2), 201-213.
33. Fujino, Y., & Matsuda, S. (2009). Prospective study of living arrangement by the ability to receive informal care and survival among Japanese elderly. Preventive Medicine, 48(1), 79-85.
34. Gliksman, M., Lazarus, R., Wilson, A., & Leeder, S. (1995). Social support, marital status and living arrangement correlates of cardiovascular disease risk factors in the elderly. Social Science & Medicine, 40(6), 811-814.
35. Gurley, R., Lum, N., Sande, M., Lo, B., & Katz, M. (1996). Persons found in their homes helpless or dead. New England Journal of Medicine, 334(26), 1710-1716.
36. Hays, J. (2002). Living arrangements and health status in later life: a review of recent literature. Public Health Nursing, 19(2), 136-151.
37. Ho, S. H. (2008). Survival analysis of living arrangements and health care utilization in terms of total mortality among the middle aged and elderly in Taiwan. The Journal of Nursing Research, 16(2), 160-168.
38. Hospers, A., Chahine, L., & Chemali, Z. (2007). Health care delivery systems for older adults: how do the Netherlands and Lebanon compare? Social Science & Medicine, 65(10), 1979-1985.
39. Homan, S., Haddock, C., Winner, C., Coe, R., & Wolinsky, F. (1986). Widowhood, sex, labor force participation, and the use of physician services by elderly adults. Journal of Gerontology, 41(6), 793-796.
40. Koskinen, S., Joutsenniemi, K., Martelin, T., & Martikainen, P. (2007). Mortality differences according to living arrangements. International journal of epidemiology, 36(6), 1255–1264.
41. Litwak, E., & Longino, C. (1987). Migration patterns among the elderly: a developmental perspective. The Gerontologist, 27(3), 266-272.
42. Li, L. W., Zhang, J., & Liang, J. (2009). Health among the oldest-old in China: which living arrangements make a difference? Social Science & Medicine, 68(2), 220-227.
43. Lund, R., Due, P., Modvig, J., Holstein, B. r. E., Mogens, Damsgaard, T., et al. (2002). Cohabitation and marital status as predictors of mortality—an eight year follow-up study. Social Science & Medicine, 55 673-679.
44. Martikainen, P., Nihtila, E., & Moustgaard, H. (2008). The effects of socioeconomic status and health on transitions in living arrangements and mortality: a longitudinal analysis of elderly Finnish men and women from 1997 to 2002. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 63(2), S99-109.
45. Mehio-Sibai, A., Beydoun, M. A., & Tohme, R. A. (2009). Living arrangements of ever-married older Lebanese women: is living with married children advantageous? Journal of Cross-Cultural Gerontology, 24(1), 5-17.
46. Morgan, L. A., & Kunkel, S. R. (2006). Ageing, Society, and the Life Course(3nd). (p. 81). New York: Springer Publishing Company
47. Moritz, D. J., & Satariano, W. A. (1993). Factors predicting stage of breast cancer at diagnosis in middle aged and elderly women: the role of living arrangements. Journal of clinical epidemiology, 46(5), 443-454.
48. Mutchler, J. E., & Burr, J. A. (1991). A longitudinal analysis of household and nonhousehold living arrangements in later life. Demography, 28(3), 375-390.
49. Oxman, T., Berkman, L., Kasl, S., Freeman, D., & Barrett, J. (1992). Social support and depressive symptoms in the elderly. American Journal of Epidemiology, 135(4), 356-368.
50. Pizzetti, P., Manfredini, M., & Lucchetti, E. (2005). Variations in late-age mortality by household structure and marital status in Parma, Italy. Ageing and Society, 25(06), 305-318.
51. Rosland, A. M., Kieffer, E., Israel, B., Cofield, M., Palmisano, G., Sinco, B., et al. (2008). When is social support important? The association of family support and professional support with specific diabetes self-management behaviors. Journal of General Internal Medicine, 23(12), 1992-1999.
52. Rogers, R. G. (1996). The effects of family composition, health, and social support linkages on mortality. Journal of Health and Social Behavior, 37(4), 326-338.
53. Shanas, E. (1979). The family as a social support system in old age. The Gerontologist, 19(2), 169-174.
54. Sibai, A., Yount, K., & Fletcher, A. (2007). Marital status, intergenerational co-residence and cardiovascular and all-cause mortality among middle-aged and older men and women during wartime in Beirut: gains and liabilities. Social Science & Medicine, 64(1), 64-76.
55. Stinner, W., Byun, Y., & Paita, L. (1990). Disability and living arrangements among elderly American men. Research on Aging, 12(3), 339-363.
56. Sugisawa, H., Liang, J., & Liu, X. (1994). Social networks, social support, and mortality among older people in Japan. Journal of Gerontology, 49(1), S3-S13.
57. UN Department of Economic and Social Affairs Population Division(2005). Living Arrangements of Older Persons Around The World.
58. Walter-Ginzburg, A., Blumstein, T., Chetrit, A., & Modan, B. (2002). Social factors and mortality in the old-old in Israel:the CALAS study. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 57(5), 308-318.
59. Wiseman, R. (1980). Why older people move: theoretical issues. Research on Aging, 2(2), 141-154.
論文全文使用權限
  • 同意授權校內瀏覽/列印電子全文服務,於2010-07-24起公開。
  • 同意授權校外瀏覽/列印電子全文服務,於2010-07-24起公開。


  • 如您有疑問,請聯絡圖書館
    聯絡電話:(06)2757575#65773
    聯絡E-mail:etds@email.ncku.edu.tw