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系統識別號 U0026-2708201816430400
論文名稱(中文) 台灣老年人休閒活動參與對認知功能軌跡之影響探討:8年追蹤研究
論文名稱(英文) The Effects of Leisure-Activity Participation on the Trajectories of Cognitive Function Among Older Adults in Taiwan:8-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 106
學期 2
出版年 107
研究生(中文) 楊慧瑩
研究生(英文) Hui-Ying Yang
電子信箱 hyy830704@gmail.com
學號 t86054050
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
共同指導教授-林聖翔
口試委員-徐慧娟
中文關鍵字 老年人  休閒活動  認知功能軌跡  影響因子  群組化軌跡分析模型 
英文關鍵字 Leisure activities  Cognitive function  Trajectories  Group-based trajectory model  Elderly 
學科別分類
中文摘要 背景:隨著老年人口快速增加,不可避免的老化議題隨之而來,而認知功能衰退為影響老年人健康的重要因子。近年來,許多研究指出,影響認知功能衰退的相關因素,相比於過去已知的因素如社會人口、遺傳、健康狀態等,日常生活型態因素更能夠被改變或調整,加上老年人多已退休無從事工作,休閒活動參與更顯重要。尤其,過去研究結果已顯示休閒活動參與是有助於延緩老年人認知功能衰退的重要保護因子。然而,過去研究對休閒活動分類方式具差異性,且多數研究並未考慮到認知功能狀態會隨時間而有所變化;縱使有認知軌跡的研究出現,多以找尋相關因素為主,目前仍未直接探討休閒活動參與對認知功能軌跡的影響。
目的:本研究的主要目的為探討台灣老年人的認知功能發展軌跡,以及了解影響認知軌跡異質性分組的相關因素之特徵性分布情形(社會人口學、健康狀態、社會支持、健康狀態等特性),並去比較智能型以及體能型等二種類型的休閒活動參與對認知功能軌跡的影響。
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」(Taiwan Longitudinal Survey on Aging, TLSA)資料庫。樣本納入條件為1999年65歲以上的台灣老年人(N=2765),排除住機構者、問卷代答者、ADL有任一項困難者、研究期間死亡或失去追蹤者以及休閒活動和認知功能遺漏者,最終樣本為1804人。追蹤時間為1999年至2007年,為8年期的世代追蹤型研究,探討1999年老年人休閒活動參與對其後續1999-2003-2007年三波認知功能之軌跡變化的影響。認知功能以簡易心智量表(SPMSQ)作為評估工具;休閒活動參與分為智能型活動以及體能型活動二類。利用群組化的軌跡分析模型(Group-based trajectory model),識別老年人的認知功能軌跡;並使用多元類別羅吉斯迴歸分析(Multinomial logistic regression),探討影響認知軌跡異質性分組的特徵性分布以及休閒活動參與對認知功能軌跡的影響。
結果:認知功能的發展軌跡以四組的異質性軌跡分組結果為最佳,四組的認知功能軌跡為「持續不佳」、「快速衰退」、「持續中度」、「維持良好」。影響四組的認知功能軌跡異質性分組的相關因素,結果顯示性別、年齡、教育程度、身體功能狀態、憂鬱、社會支持等因子與認知軌跡分組有顯著相關。老年人參與智能型或體能型活動的項目數愈多,對發展成較差的認知軌跡愈具有保護效應;智能型活動中度參與者,相較於低度者,較不容易轉變為持續不佳或持續中度的軌跡組別;體能型活動高度參與,對持續不佳的認知軌跡具有保護效果。
結論:研究結果指出台灣老年人會面臨不同程度的認知功能衰退,呈現多種認知功能軌跡型態。休閒活動參與有助於避免老年人發展為較差的認知功能軌跡,有利於認知功能的維持,建議政府應該鼓勵民眾積極參與各種休閒活動,並訂定相關預防認知功能衰退的策略以及政策。
英文摘要 Studies have showed that participation in leisure activities has positive effects on cognitive function for the elderly. However, most previous studies have ignored the changing effects of cognitive function over time. Limited research has focused on the effects of leisure activity on the trajectory of cognitive function in the elderly. The purpose of this longitudinal study was firstly to examine the developmental trajectory of cognitive function in Taiwanese elderly and to understand the characteristics of related factors (sociodemography, health status, social support, health status, etc.) affecting the heterogeneity grouping of cognitive trajectories. The second objective of the study was to compare the effects of two types of leisure activities (intellectual and physical) on the trajectories of cognitive function in Taiwan.
Data came from 1804 participants aged 65 or older who were dwelling in the community and selecting from the 1999 to 2007 “Taiwan Longitudinal Survey on Aging, TLSA”. The participation of leisure-activity was classified into two categories, intellectual activities and physical activities. The total score of leisure-activity ranged from 0 to 5 for intellectual activities, and 0 to 4 for physical activities. Cognitive function was measured by the 9-item Short Portable Mental Status Questionnaires (SPMSQ). The group-based trajectory model was used to determine the cognitive decline trajectories, and multinomial logistic regression was applied to explore the the effects of leisure-activity participation on the trajectories of cognitive function and related factors.
Results showed that four groups of heterogeneous trajectories indicated a good implication, which can be named as “persistent poor”, “rapid decline”, “stable moderate”, and “maintaining good”. The characteristics of maintaining good cognitive trajectory were male, younger, higher education, better physical function, lower depression scores, higher social support, and participate in various leisure activities. The more leisure activities participation, the less likely to develop as persistent poor trajectory. For intellectual activities, moderate level of participation was less likely to be “persistent poor” and “stable moderate” group. As to physical activities, the higher level of participation was less likely to be “persistent poor” group.
We concluded that participation in leisure activities would help prevent the elderly from developing into a poor cognitive function trajectory. The government should encourage people to participate in various leisure activities actively and formulate strategies and policies to prevent cognitive decline.
論文目次 第壹章 前言 1
第一節 研究背景 1
第二節 研究目的 2
第三節 研究假設 3
第貳章 文獻探討 4
第一節 老年人的認知功能障礙 4
第二節 認知功能的變化及影響因子 5
第三節 老年人的休閒活動參與 17
第四節 休閒活動與認知功能之關係 23
第五節 軌跡分析 26
第六節 文獻總結及知識缺口 27
第參章 研究方法 28
第一節 資料來源 28
第二節 研究對象 30
第三節 研究設計與研究架構 35
第四節 研究變項定義與測量 36
第五節 統計分析 41
第肆章 研究結果 43
第一節 研究樣本描述 43
第二節 影響休閒活動參與之雙變數分析 53
第三節 影響認知功能總分及障礙之雙變數分析 56
第四節 軌跡分析 59
第五節 認知功能軌跡分組之樣本特徵性分布 65
第六節 二種休閒活動參與對四組認知功能軌跡之影響 71
第伍章 討論 81
第一節 主要研究發現 81
第二節 對研究結果的解釋與對話 82
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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