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系統識別號 U0026-1107201718105700
論文名稱(中文) 老年人旅遊與其存活影響之分析:8年追蹤研究
論文名稱(英文) Effects of Tourism on the Survival of Older Adults in Taiwan:an Eight-year Follow-up Study
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 105
學期 2
出版年 106
研究生(中文) 郭品漢
研究生(英文) Pin-Han Kuo
學號 T86044013
學位類別 碩士
語文別 中文
論文頁數 99頁
口試委員 指導教授-胡淑貞
口試委員-王榮德
召集委員-邱靜如
中文關鍵字 老年人  活躍老化  旅遊  死亡風險  時間相依共變數之存活分析 
英文關鍵字 old adults  active aging  tourism  survival  cox proportional hazard model with time-dependent covariate 
學科別分類
中文摘要 背景:高齡化的時代,年長者旅遊會是旅遊業的主要客源,旅遊對於老年人而言,富含著社會連結及獨立生活的意義,且同時呼應歐盟提出活躍老化指數的指標。然而,過去文獻在探討旅遊對於老年人健康影響上,僅限於主觀情感測量,旅遊對於老年人長期身體狀況影響的研究仍十分缺乏。
目的:本研究主要目的有二,首先探討影響高齡者旅遊型態之因子,二為探討台灣老年人出遊因素及旅遊行為與其八年的死亡風險之影響,並針對性別、經濟困難程度、憂鬱程度做分層分析。
方法:使用台灣中老年身心社會生活狀況調查長期追蹤資料庫,納入1999年滿65歲的老年人,並排除住機構、ADL≧1、旅遊題目無回應、移民於國外,1999-2000年內死亡的樣本後,最終樣本數為2,433人。旅遊狀態分為無旅遊、純國內旅遊、國外旅遊,追蹤樣本至2007年12月31日為止的存活狀態,研究分析上考慮了社會人口變項、健康相關變項、慢性疾病。探討影響高齡者旅遊型態使用多元羅吉斯回歸模型得出各變項中在旅遊型態上的OR值,存活分析則使用時間相依共變數之存活分析,以得出老年人旅遊與其八年死亡風險的HR值。
結果:在2,433位起始樣本中,55.16%為男性,59.73%年齡未滿75歲。在旅遊型態上,有1,346位(55.32%)為無旅遊,664位(27.29%)為純國內旅遊,423位(17.39%)為國外旅遊。老年人生活開銷困難、CESD≧10(有憂鬱情緒者)、行動力中度障礙影響,皆會降低他們在國內外出遊的機會。女性、仍在工作者、有社團組織參與、前一波有旅遊經驗及有運動習慣者,皆有較高的機會在國內旅遊。國外旅遊則是當教育程度越高、社團組織參與至少兩項以上及前一波有旅遊經驗時,會增加其出國旅遊機會。在控制完所有變項後,相較於無旅遊族群,國內旅遊可以降低約18%的八年死亡風險,國外旅遊則可降低約30%。其中又以男性的效果最為顯著,男性無論是國內旅遊及國外旅遊皆可降低約26%的死亡風險,旅遊對於女性、經濟開銷有困難的族群及有憂鬱情緒的族群,在八年死亡風險上則無顯著的保護作用。
結論:當老年人生活開銷有困難、有憂鬱情緒(CESD≧10)、行動力達重度以上障礙,都會減少其出遊機會行為,雖然國外旅遊的可近性不及國內旅遊,但是無論在國內旅遊或是國外,旅遊對於老年人的死亡風險是有正面效應的,其中又對男性的效果最大。前一波旅遊行為雖然影響著之後的旅遊行為,但是對於長期存活效應是無影響的。
英文摘要 INTRODUVTION: The purpose of the study is to examine the effects of tourism on the survival of older adults and identify the factor associated with the travel behavior among old adults in Taiwan.
METHODS: This study used the nationally representative dataset “Taiwan Longitudinal Study on Aging (TLSA)” and analyzed three waves of the database (1999, 2003 and 2007). A total 2,433 old adults aged 65 years and over was recruited in 1999 and followed up their survival until 2007. Travel status in 1999 was divided into three groups: (1) No travel, (2) Domestic travel, (3) Travel abroad. The covariates included demographics, health behaviors, depression, mobility and comorbidities. Multinomial Logistic Regression was used for exploring whether old adults had different factor in choosing travel status. Cox proportional hazard model with time-dependent covariate was used for evaluating the effects of tourism on the survival of all old adults, gender difference, living expense hardship, depression status.
RESULTS: Factors associated with domestic travel or travel abroad were different. Living expense hardship, depression and difficulty in mobility were the main reasons related to the decreasing to travel. Domestic travel could lower 18% mortality risk, whereas travel abroad could lower 30% risk on older adults. No matter domestic travel or travel abroad, men could lower mortality risk higher than women.
Conclusion: Tourism had the protective effects on old adults after eight-year follow up and it had stronger effect on male than female.
論文目次 目錄
第壹章 前言 1
第一節 研究重要性 1
第二節 研究目的 7
第三節 研究假設 8
第貳章 文獻回顧 9
第一節 活動理論(Activity Theory) 9
第二節 Social Tourism 10
第三節 社會參與對死亡風險之影響 11
第四節 影響高齡者旅遊因子 19
第五節 旅遊對老年人健康之影響 22
第六節 小結 28
第參章 研究設計與方法 29
第一節 研究資料來源 29
第二節 研究對象 30
第三節 研究設計與研究架構 31
第四節 研究變項定義 34
第五節:統計分析 39
第肆章 研究結果 42
第一節 樣本各變項於三波之描述性分析 42
第二節 各變項與旅遊型態之雙變項分析 47
第三節 各變項與存活狀態之雙變項分析 54
第四節 高齡者出遊相關因子分析 58
第五節 時間相依共變數之存活分析 62
第六節 時間相依共變數存活分析之分層分析 69
第伍章 討論 77
第一節 本研究主要發現 77
第二節 影響老年人出遊之討論 78
第三節 老年人出遊與死亡風險之討論 80
第四節 本研究優勢與限制 83
第五節 結論與建議 84
參考文獻 86
附件:補充表格…………………………………………………………….….91
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