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系統識別號 U0026-1808201617372800
論文名稱(中文) 中高齡工作轉換對身心健康的影響:11年追蹤研究
論文名稱(英文) The effect of work transition on physical and mental health of middle-aged and older adults:11-years 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 104
學期 2
出版年 105
研究生(中文) 林彥蘋
研究生(英文) Yan-Ping Lin
電子信箱 a3566468@hotmail.com
學號 T86031010
學位類別 碩士
語文別 中文
論文頁數 96頁
口試委員 指導教授-胡淑貞
口試委員-邱靜如
口試委員-翁慧卿
中文關鍵字 工作轉換  行動困難度  心理健康  中老年人  長期追蹤研究  階層線性模型 
英文關鍵字 working transition  mental health  physical function  middle-aged and older adults  follow-up 
學科別分類
中文摘要 背景:因應全球老化造成勞動力市場短缺,延長法定退休年齡或鼓勵老年人從事退休後再就業,不僅能舒緩勞動力短缺的問題,更能減少大量退休人口造成退休金及社會支持的需求。然而,過去文獻對工作與退休對身心健康的影響尚未出現定論,且大多數文獻僅僅比較工作與退休對象健康的差異性,並無深入探討不同離開職場因素對後續健康的差異性。

目的:本研究目的為探討台灣地區中老年人歷經不同類型之工作與退休轉換(包含持續工作、屆齡退休、因健康因素離職、非自願性離職、因其他因素離職、重回職場)對身體功能及心理健康的影響。
方法:使用「台灣地區中老年身心社會生活狀況長期追蹤調查」在1996年調查中50到74歲族群(N=4061),排除ADL>0、住機構、代答族群及失去追蹤樣本後研究樣本N=3548。經歷1999年調查工作轉變後將樣本分為持續工作組、離開職場組、重回職場組與一直無工作組。進而將離開職場原因細分產生屆齡退休組、因健康因素離職組、非自願性離職組、其他因素離職組,產生7種工作轉換組別:(1)持續工作組(2)屆齡退休組(3)因健康因素離職組(4)非自願性離職組(5)其他因素離職組(6)重回職場組(7)一直無工作組。並持續追蹤7種工作轉換至2007年探討身心健康的變化。身體功能採用行動困難度測量,以9題行動困難度量表調查中老年人行動困難度狀況,加總後形成行動困難度困難分數,分數越高代表行動困難度越高。心理健康以10題憂鬱量表CES-D調查中老年人憂鬱狀況,分數越高代表愈憂鬱。統計分析使用階層線性模型(Hierachical Linear Modeling,HLM)進行重複測量研究分析,控制社會人口學變項(包含職業、收入)、健康狀況(自覺健康、慢性病數)、健康行為(包含吸菸、飲酒、運動),調查各工作轉換組別個體身心健康11年變化的差異性。

結果:本研究約一半的參與者為男性,且少於15%的參與者教育程度在高中以上。平均CES-D-10分數在11年間從4.91±5.37增加至5.07±5.83。平均行動困難分數在8年間從2.92±4.81增加至5.65±7.27。憂鬱分數與身體功能困難數與四種工作轉換組別呈顯著差異;一直無工作者平均憂鬱分數與平均身體功能困難數分數最高;第二高為離開職場組。在心理健康研究結果的部分,與持續工作組相比,因健康因素離職者與一直無工作者有顯著較高的憂鬱狀況。然而,在控制健康狀態及健康行為後,一直無工作者的心理健康則呈現無顯著差異,僅剩因健康因素離職表達顯著差異(ß=1.9063, P=0.0047)。在身體功能研究結果的部分,與持續工作組相比,因健康因素離職者與一直無工作者有顯著較高的身體功能困難數(ß=2.8419, P<0.0001, ß=1.4151, P<0.0001)。屆齡退休、因其他因素離職者在身體功能及憂鬱分數高於持續工作者。但皆無顯著差異。值得注意的是時間與工作轉換在一直處於無工作的組別對行動困難度的影響有顯著的交互作用。

討論:全球勞動力老化已經是不爭的事實,建議未來政府為應為有健康問題的工作者、一直無工作者及重回職場者提供資源,發展特殊法案規範老年人工作時數與內容,並提供新興技術輔導以減少健康風險,維持老年人健康。這些建議並不意謂強迫每位老年人都要繼續工作,而是希望能夠減少老年人退休後重返職場的障礙與就業風險,增進老年人身心健康。
英文摘要 The purpose of this study is to examine the effects of mental health change among 5 types of working transition in middle-aged and older adults in Taiwan.
A nationally representative dataset “Taiwan Longitudinal Study on Aging (TLSA)” was used in this study and three waves of survey were analyzed. A total of 2034 samples aged between 55-74 years was recruited in 1999. Working transition was divided into seven groups: (1) continuing employed, (2) statutory retirement, (3) leaving work due to ill-health, (4) leaving work due to other reasons, (5) leaving work involuntarily, (6) returning to workplace, and (7) continuing unemployed. Mental health was measured by the Center for Epidemiologic Studies Short Depression Scale (CES-D-10). Physical function was measured by asking the difficulty of 9 questions. Hierarchical linear modeling was used to analyze long-term effects for repeated measurements.
The results show that compared to continuing employed group, those in the group of leaving work due to ill-health, and continuing unemployed were significantly associated with poorer physical and mental health.

論文目次 第壹章 前言………………………………………………………………………………… 1
第一節 研究重要性…………………………………………………………… 1
第二節 研究目的………………………………………………………………… 4
第三節 研究架構………………………………………………………………… 5
第四節 研究假設………………………………………………………………… 6
第貳章 文獻回顧…………………………………………………………………………… 7
第一節 全球老化與職場人口組成變異………………………… 7
第二節 台灣勞動市場現況………………………………………………… 8
第三節 工作轉換對心理健康的影響……………………………… 10
第四節 工作轉換對身體功能的影響……………………………… 24
第五節 工作與健康相關理論…………………………………………… 35
第參章 研究方法…………………………………………………………………………… 37
第一節 資料來源與研究對象…………………………………………… 37
第二節 研究變項及定義…………………………………………………… 40
第三節 統計分析方法………………………………………………………… 46
第肆章 研究結果…………………………………………………………………………… 50
第一節 研究樣本描述…………………… 50
第二節 工作轉變之樣本雙變項分析……………………………… 54
第三節 各組工作轉換對憂鬱之多變量分析………………… 66
第四節 各組工作轉變對行動困難度之多變量分析…… 76
第伍章 討論………………………………………………………………………………… 86
第一節 主要研究發現…………………………………………………………… 86
第二節 對研究的解釋與對話……………………………………………… 87
第三節 研究優勢與限制……………………………………………………… 89
第四節 結論與建議……………………………………………………………… 91
參考文獻……………………………………………………………………………………… 93
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